Research into the financial performance of Medicare accountable care organizations (ACOs) has found that organizations benefit from having prior experience with risk-bearing contracts, but that organizations that had reduced growth in healthcare spending before joining an ACO would find it difficult to improve further and share in savings, according to Marietou Ouayogode, PhD.
Research into the financial performance of Medicare accountable care organizations (ACOs) has found that organizations benefit from having prior experience with risk-bearing contracts, but that organizations that had reduced growth in healthcare spending before joining an ACO would find it difficult to improve further and share in savings, according to Mariétou Ouayogodé, PhD, post-doctoral fellow at The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth.
Transcript
Accountable care organizations are a few years old now: what have we learned about their financial performance?
In terms of financial performance we've seen that there's a lot of variation across organizations, and what we found was that prior experience with risk-bearing contracts, although it is not a compulsory condition, it did help. And it is suggesting that organizations with such experience have greater probability of doing better in this kind of environment.
Another thing that we learned was it takes time. So some organizations were not efficient—were high spenders to start with—may take a little more time to get to the point where they achieve savings and eventually earn shared savings. And what we've learned from our analysis is that efficient organizations—those that were able to reduce the growth in healthcare spending for their attributed beneficiaries—would find it a little more difficult. If they did that prior to implementing the ACO model, once they were in the ACO, since they already reduced so much of the waste, it will be very difficult now to reduce. There's not much left to purge out. As opposed to those who had more waste at baseline.
So the model is essentially creating, in a way, more opportunities for those who had more waste at baseline to achieve savings and eventually get shared savings from Medicare.
CMS released a final rule to help patients obtain Children’s Health Insurance Program (CHIP) coverage and issued a proposed rule to update Medicare payment policies and rates for inpatient rehabilitation facilities; debate over if gift card incentives are acceptable in health care marketing.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen
Increasing Lp(a) Awareness for Better Cardiovascular Health: Dr Mary McGowan
March 24th 2024For Lp(a) Awareness Day, Mary McGowan, MD, FNLA, chief medical officer of the Family Heart Foundation, highlights how most people with elevated Lp(a) are completely unaware that they have this increased risk and calls for increased testing.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
A global AIDS program that was in limbo for months got temporary relief after congressional negotiators agreed to a 1-year renewal in the next government funding package; the outcome of the November presidential election could determine the state of fetal tissue research in the US; federal officials and industry executives failed to make improvements that stop hacking attacks.
Read More
Covered Preventive Services at Risk: V-BID Summit Breaks Down the Braidwood v Becerra Case
March 20th 2024For more than a decade, certain high-value preventive care services have been covered at no cost to patients under the Affordable Care Act, but a current legal challenge has the coverage at risk.
Read More