Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA.
Health Aff (Millwood). 2012 Nov;31(11):2395-406. doi: 10.1377/hlthaff.2011.1219.
This cross-site comparison of the early experience of four provider organizations participating in the Brookings-Dartmouth Accountable Care Organization Collaborative identifies factors that sites perceived as enablers of successful ACO formation and performance. The four pilots varied in size, with between 7,000 and 50,000 attributed patients and 90 to 2,700 participating physicians. The sites had varying degrees of experience with performance-based payments; however, all formed collaborative new relationships with payers and created shared savings agreements linked to performance on quality measures. Each organization devoted major efforts to physician engagement. Policy makers now need to consider how to support and provide incentives for the successful formation of multipayer ACOs, and how to align private-sector and CMS performance measures. Linking providers to learning networks where payers and providers can address common technical issues could help. These sites' transitions to the new payment model constitutes an ongoing journey that will require continual adaptation in the structure of contracts and organizational attributes.
本研究对参与布鲁金斯-达特茅斯问责制医疗组织合作项目的四家医疗机构的早期经验进行了跨站点比较，确定了各机构认为有助于成功组建和运营 ACO 的因素。这四个试点项目的规模不同，归因患者数在 7000 至 50000 之间，参与医师数在 90 至 2700 之间。各试点对基于绩效的支付方式的经验程度不同；但是，所有试点都与支付方建立了合作新关系，并制定了与质量措施绩效挂钩的共享节约协议。每个组织都投入了大量精力来促进医生的参与。政策制定者现在需要考虑如何支持和激励多付款方 ACO 的成功组建，并协调私营部门和 CMS 的绩效衡量标准。将提供者与学习网络联系起来，使支付方和提供者能够解决共同的技术问题，可能会有所帮助。这些机构向新的支付模式的过渡是一个持续的过程，这将需要不断调整合同结构和组织属性。
