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Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings
David B. Muhlestein, PhD, JD; Spencer Q. Morrison, BA; Robert S. Saunders, PhD; William K. Bleser, PhD, MSPH; Mark B. McClellan, MD, PhD; and Lia D. Winfield, PhD
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Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings

David B. Muhlestein, PhD, JD; Spencer Q. Morrison, BA; Robert S. Saunders, PhD; William K. Bleser, PhD, MSPH; Mark B. McClellan, MD, PhD; and Lia D. Winfield, PhD
From 2013 to 2016, successful Medicare Shared Savings Program accountable care organizations reduced spending by shifting expenditures from the inpatient and postacute care setting to the physician office setting.

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Author Affiliations: Leavitt Partners (DBM), Washington, DC; Leavitt Partners (SQM, LDW), Salt Lake City, UT; Robert J. Margolis, MD, Center for Health Policy, Duke University (RSS, WKB, MBM), Washington, DC.

Source of Funding: None.

Author Disclosures: Dr Muhlestein, Mr Morrison, and Dr Winfield are employed by Leavitt Partners, which consults about ACOs and works with providers and ACOs. Dr Muhlestein has given speeches that included ACO research, some of which provided travel expenses or small honoraria, and has attended multiple ACO conferences. He has received grants from the Commonweath Fund and the Gordon and Betty Moore Foundation for work on ACOs. Dr Saunders, Dr Bleser, and Dr McClellan are employed by Duke University, which has an ACO that was not involved with this research, nor did it fund the research in this paper. They have attended meetings of the Health Care Payment Learning and Action Network and the Accountable Care Learning Collaborative. They have a grant unrelated to this manuscript from the Moore Foundation to study ACOs, and Dr McClellan also has a grant unrelated to this manuscript from the Commonwealth Fund to study global best practices in accountable care. Dr McClellan is co-chair of the Health Care Payment Learning and Action Network and co-chair of the Accountable Care Learning Collaborative. The authors report no other relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (DBM, SQM, RSS, WKB, MBM); acquisition of data (DBM, SQM, RSS, WKB); analysis and interpretation of data (DBM, SQM, RSS, WKB, MBM, LDW); drafting of the manuscript (DBM, SQM, RSS, WKB, LDW); critical revision of the manuscript for important intellectual content (DBM, SQM, RSS, WKB, MBM, LDW); statistical analysis (DBM, SQM, RSS, WKB); administrative, technical, or logistic support (RSS, WKB, LDW); and supervision (RSS).

Send Correspondence to: Lia D. Winfield, PhD, Leavitt Partners, 299 S Main St, Ste 2300, Salt Lake City, UT 84111. Email: lia.winfield@leavittpartners.com.
 
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