Askar S. Chukmaitov, MD, PhD, is Associate Professor, Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, Virginia. E-mail:
Health Care Manage Rev. 2019 Apr/Jun;44(2):104-114. doi: 10.1097/HMR.0000000000000182.
In 2012, the Centers for Medicare and Medicaid Services (CMS) initiated the Medicare Shared Savings Program (MSSP) and Pioneer Accountable Care Organization (ACO) programs. Organizations in the MSSP model shared cost savings they generated with CMS, and those in the Pioneer program shared both savings and losses. It is largely unknown what hospital and environmental characteristics are associated with the development of CMS ACOs with one- or two-sided risk models.
The aim of this study was to assess the organizational and environmental characteristics associated with hospital participation in the MSSP and Pioneer ACOs.
Hospitals participating in CMS ACO programs were identified using primary and secondary data. The ACO hospital sample was linked with the American Hospital Association, Health Information and Management System Society, and other data sets. Multinomial probit models were estimated that distinguished organizational and environmental factors associated with hospital participation in the MSSP and Pioneer ACOs.
Hospital participation in both CMS ACO programs was associated with prior experience with risk-based payments and care management programs, advanced health information technology, and location in higher-income and more competitive areas. Whereas various health system types were associated with hospital participation in the MSSP, centralized health systems, higher numbers of physicians in tightly integrated physician-organizational arrangements, and location in areas with greater supply of primary care physicians were associated with Pioneer ACOs. Favorable hospital characteristics were, in the aggregate, more important than favorable environmental factors for MSSP participation.
MSSP ACOs may look for broader organizational capabilities from participating hospitals that may be reflective of a wide range of providers participating in diverse markets. Pioneer ACOs may rely on specific hospital and environmental characteristics to achieve quality and spending targets set for two-sided contracts.
Hospital and ACO leaders can use our results to identify hospitals with certain characteristics favorable to their participation in either one- or two-sided ACOs.
2012 年，医疗保险和医疗补助服务中心（CMS）启动了医疗保险储蓄计划（MSSP）和先锋责任医疗组织（ACO）计划。在 MSSP 模式下，参与的组织与 CMS 分享节省的成本，而在先锋计划下，参与的组织分享节省和损失。目前尚不清楚具有单边或双边风险模型的 CMS ACO 与医院和环境特征有何关联。
本研究旨在评估与医院参与 MSSP 和先锋 ACO 相关的组织和环境特征。
使用主要和次要数据确定参与 CMS ACO 计划的医院。使用多变量概率模型，将 ACO 医院样本与美国医院协会、健康信息和管理系统协会以及其他数据集进行关联。该模型区分了与医院参与 MSSP 和先锋 ACO 相关的组织和环境因素。
医院参与这两个 CMS ACO 计划与基于风险的支付和护理管理计划、先进的健康信息技术以及高收入和竞争更激烈地区的先前经验有关。虽然各种医疗系统类型与医院参与 MSSP 有关，但集中的医疗系统、更紧密整合的医生组织安排中的更多医生数量以及在初级保健医生供应更多的地区参与与先锋 ACO 有关。与 MSSP 参与相比，有利的医院特征总体上比有利的环境因素更为重要。
MSSP ACO 可能会从参与医院寻找更广泛的组织能力，这些能力可能反映出参与不同市场的各种提供者。先锋 ACO 可能依赖于特定的医院和环境特征来实现为双边合同设定的质量和支出目标。
医院和 ACO 领导者可以利用我们的研究结果，确定具有对其参与单边或双边 ACO 有利的某些特征的医院。
