| Autor: |
Bleser WK; William K. Bleser ( william.bleser@duke.edu ) is a research associate at the Duke-Margolis Center for Health Policy, Duke University, in Washington, D.C., Saunders RS; Robert S. Saunders is a research director at the Duke-Margolis Center for Health Policy, Duke University, in Washington., Muhlestein DB; David B. Muhlestein is chief research officer at Leavitt Partners in Washington, D.C., and an adjunct assistant professor at the Dartmouth Institute, Geisel School of Medicine, Dartmouth College, in Hanover, New Hampshire., McClellan M; Mark McClellan is director of the Duke-Margolis Center for Health Policy in Washington and the Robert J. Margolis Professor of Business, Medicine, and Policy at Duke University in Durham, North Carolina. |
| Jazyk: |
angličtina |
| Zdroj: |
Health affairs (Project Hope) [Health Aff (Millwood)] 2019 May; Vol. 38 (5), pp. 794-803. |
| DOI: |
10.1377/hlthaff.2018.05097 |
| Abstrakt: |
The ability of accountable care organizations (ACOs) to continue reducing costs and improving quality depends on understanding what affects their survival. We examined such factors for survival in the Medicare Shared Savings Program (MSSP) of 624 ACOs between performance years 2013 and 2017 (1,849 ACO-years). Overall, ACO exits from the MSSP decreased after ACOs' third year. Shared-savings bonus payment achievement, more care coordination, higher financial performance benchmarks, market-level Medicare cost growth, lower-risk patients, and contracts with upside-only risk were associated with longer survival. Quality scores, postacute care spending, organizational traits, and most market-context characteristics had no significant association with survival, which indicates that diverse organizations and markets can be successful. Put in context with the recently finalized MSSP rule from December 2018, our findings suggest that while new flexibilities for low-revenue ACOs likely reduce uncertainty for some, MSSP ACOs may need more than the new period of one to three years to prepare for downside risk. Policy makers should offer more support to ACOs (especially those with higher-risk patients) for building organizational competencies and should consider how benchmarking policy can fairly assess ACOs from regions with differing levels of cost growth. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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