A recent paper in JAMA Internal Medicine examined the accountable care organization programs in Colorado and Oregon to determine their impacts on spending, access, and utilization.
The nation’s move from fee-for-service and the implementation of the Medicare Access and CHIP Reauthorization Act have placed more emphasis on the success of new delivery models such as accountable care organizations (ACOs). A recent paper in JAMA Internal Medicine examined the ACO programs in Colorado and Oregon to determine their impacts on spending, access, and utilization.
Oregon initiated its ACO program—moving most Medicaid enrollees into 16 Coordinated Care Organizations (CCOs)—in 2012, while Colorado created 7 Regional Care Collaborative Organizations (RCCOs) in 2011 as part of its Medicaid Accountable Care Collaborative (ACC). These 2 states represent early adoption of the Medicaid ACO model.
The Oregon program managed care within a global budget with CCOs accepting full financial risk for the patient population, while the Colorado program provided per member per month funding to the RCCOs to coordinate care and connect Medicaid enrollees with community services.
The researchers compared performance in Oregon’s CCO model with Colorado’s ACC model. They analyzed claims data from each state’s Medicaid agency for 18 months of preintervention data and 24 months of postintervention data.
“More than 2 years into their programs, both states can point to successes,” the authors determined.
Both states reported reductions in measures of standardized expenditures and utilization. But the researchers found that the Oregon model was not associated with a reduction in standardized expenditures for some services when compared with Colorado. In addition, while both states saw decreased primary care visits, they were significantly lower in Oregon than in Colorado in 2014.
Compared with Colorado, Oregon’s CCO model saw improvements in 3 of 4 Healthcare Effectiveness Data and Information Set access measures, as well as reductions in both avoidable emergency department visits and preventable acute hospital admissions. However, the CCO model was not associated with significant improvements in 3 of 4 measures of low-value care compared with Colorado.
“Compared with Colorado, Oregon experienced improvements in some access and quality measures, but did not generate savings that might be anticipated with its ambitious reform model and the $1.9 billion federal investment to support the CCO transformation,” the authors wrote.
They determined that Colorado’s ACC model might represent a more promising delivery system reform option for other states to adopt.
“The incentives in most existing alternative payment models, including ACOs, are commonly considered insufficient to result in behavior change,” Carrie H. Colla, PhD, and Elliott S. Fisher, MD, MPH, wrote in an accompanying commentary. “However, the Colorado study suggests that strong incentives may not be necessary. Rather, the Colorado medical home model improved value through supporting providers with coaching, connecting members with nonmedical services, and providing feedback on costs, utilization, and outcomes.”
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
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
December 19th 2023Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
Listen
Evolution of HDHPs With VBID Components Can Improve Care for Chronic Disease
March 14th 2024Over the course of the last 20 years, high-deductible health plans (HDHPs) have undergone an evolution. Today’s plans, with more high-value services covered predeductible, can improve care for people with chronic diseases, said panelists at the 2024 Value-Based Insurance Design (V-BID) Summit.
Read More
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
Listen