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Health Aff (Millwood). 2017 Apr 1;36(4):640-648. doi: 10.1377/hlthaff.2016.1107.

Substantial Physician Turnover And Beneficiary 'Churn' In A Large Medicare Pioneer ACO.

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John Hsu ( is director of the Clinical Economics and Policy Analysis Program at the Mongan Institute, Massachusetts General Hospital (MGH), which is a part of the Partners Healthcare system, and an associate professor in the Department of Medicine and in the Department of Health Care Policy at Harvard Medical School, both in Boston.
Christine Vogeli is an assistant professor of medicine at MGH.
Mary Price is an analyst at the Mongan Institute, MGH.
Richard Brand is a professor emeritus in the Department of Epidemiology and Biostatistics at the University of California, San Francisco.
Michael E. Chernew is a professor in the Department of Health Care Policy at Harvard Medical School.
Namita Mohta is a faculty member at the Center for Healthcare Delivery Sciences and a hospitalist at Brigham and Women's Hospital, which is part of the Partners Healthcare system, both in Boston.
Sreekanth K. Chaguturu is vice president for population health at Partners HealthCare; a staff physician at MGH; and an instructor in medicine at Harvard Medical School, all in Boston.
Eric Weil is senior medical director for population health, Partners HealthCare; associate medical director of the Massachusetts General Physicians Organization; and associate chief of clinical affairs, Division of General Internal Medicine, MGH, all in Boston.
Timothy G. Ferris is the senior vice president for population health at Partners HealthCare and MGH and an associate professor of Medicine at MGH and Harvard Medical School, all in Boston.


Alternative payment models, such as accountable care organizations (ACOs), attempt to stimulate improvements in care delivery by better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, we found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel). We also found substantial physician turnover: More than half of physicians either joined (41 percent) or left (18 percent) the ACO during the 2012-14 contract period studied. When physicians left the ACO, most of their attributed beneficiaries also left the ACO. Conversely, about half of the growth in the beneficiary population was because of new physicians affiliating with the ACO; the remainder joined after switching physicians. These findings may help explain the muted financial impact ACOs have had overall, and they raise the possibility of future gaming on the part of ACOs to artificially control spending. Policy refinements include coordinated and standardized risk-sharing parameters across payers to prevent any dilution of the payment incentives or confusion from a cacophony of incentives across payers.


Medicare; Physician participation; Pioneer ACO

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