J. Michael McWilliams (
Michael E. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy in the Department of Health Care Policy, Harvard Medical School.
Health Aff (Millwood). 2017 Dec;36(12):2085-2093. doi: 10.1377/hlthaff.2017.0814.
It has been widely assumed that better management and coordination of care for chronic conditions and high-risk patients would be the leading mechanisms for achieving savings in accountable care organizations (ACOs), specifically by reducing acute care needs through enhanced outpatient and preventive care. We examined the extent to which changes in spending and hospitalizations for ACO patients in the Medicare Shared Savings Program (MSSP) have been consistent with this expectation. By 2014, participation in the MSSP was associated with significant reductions in total Medicare fee-for-service spending for ACO patients but with proportionately smaller reductions in hospitalizations and some increases in hospitalizations for ambulatory care-sensitive conditions. In addition, spending reductions were not clearly concentrated among high-risk patients: Reductions for those patients accounted for only 38 percent of the total reduction among ACOs entering the MSSP in 2012, and reductions among 2013 MSSP entrants were almost entirely concentrated among lower-risk patients. These findings suggest that, on average, care coordination and management efforts focused on ambulatory care-sensitive conditions and high-risk patients have not been the major drivers of early savings in the MSSP.
人们普遍认为，更好地管理和协调慢性病和高危患者的护理将是实现问责制医疗组织（ACO）节约的主要机制，特别是通过加强门诊和预防保健来减少急性护理需求。我们研究了医疗保险共享储蓄计划（MSSP）中 ACO 患者的支出和住院变化在多大程度上符合这一预期。到 2014 年，参与 MSSP 与 ACO 患者的医疗保险总费用支出显著减少有关，但住院率的降幅相对较小，一些门诊护理敏感疾病的住院率有所增加。此外，支出减少并未明显集中在高风险患者中：这些患者的减少仅占 2012 年进入 MSSP 的 ACO 总减少额的 38%，而 2013 年 MSSP 参与者的减少额几乎完全集中在低风险患者中。这些发现表明，平均而言，专注于门诊护理敏感疾病和高风险患者的护理协调和管理工作并不是 MSSP 早期节约的主要驱动因素。
