Kury Fabricio S P, Baik Seo H, McDonald Clement J
Lister Hill National Center for Biomedical Communications, National Library of Medicine, U.S. National Institutes of Health, Bethesda, Maryland, USA.
AMIA Annu Symp Proc. 2017 Feb 10;2016:724-733. eCollection 2016.
The Medicare Shared Savings Program (MSSP) is the larger of the first two Accountable Care Organization (ACO) programs by the Centers for Medicare and Medicaid Services (CMS). In this study we assessed healthcare cost and utilization of 1.71 million Medicare beneficiaries assigned to the 333 MSSP ACOs in the calendar years of 2013 and 2014, in comparison to years 2010 and 2011, using the official CMS data. We employed doubly robust estimation (propensity score weighting followed by generalized linear regression) to adjust the analyses to beneficiary personal traits, history of chronic conditions, previous healthcare utilization, ACO administrative region, and ZIP code socioeconomic factors. In comparison to the care delivered to the control cohort of 17.7 million non-ACO beneficiaries, we found that the care patterns for ACO beneficiaries shifted away from some costly types of care, but at the expense of increased utilization of other types, increased imaging and testing expenditures, and increased medication use, with overall net greater increase in cost instead of smaller increase.
医疗保险共同节约计划（MSSP）是医疗保险和医疗补助服务中心（CMS）推出的前两个责任医疗组织（ACO）计划中规模较大的一个。在本研究中，我们使用CMS官方数据，评估了2013年和2014年分配到333个MSSP ACO的171万医疗保险受益人的医疗成本和医疗服务利用情况，并与2010年和2011年进行了比较。我们采用双重稳健估计（倾向得分加权后进行广义线性回归），将分析调整为考虑受益人的个人特征、慢性病病史、先前的医疗服务利用情况、ACO行政区域以及邮政编码社会经济因素。与为1770万非ACO受益人组成的对照队列提供的医疗服务相比，我们发现ACO受益人的医疗模式从一些成本较高的医疗类型转变，但代价是其他类型的利用增加、影像和检测支出增加以及药物使用增加，总体净成本增加更多而非更少。
