Office of Health Policy, Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, Washington, District of Columbia, USA.
School of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA.
Popul Health Manag. 2021 Jun;24(3):360-368. doi: 10.1089/pop.2020.0060. Epub 2020 Aug 10.
Medicare Accountable Care Organizations (ACOs) have achieved high-quality performance and recent cost savings, but little is known about how local market conditions influence provider adoption. The authors describe physician practice participation in Medicare ACOs at the county level and use adjusted logistic regression to assess the association between ACO presence and 3 characteristics hypothesized to influence ACO formation: physician market concentration, Medicare Advantage (MA) penetration, and commercial health insurance market concentration. Analyses are repeated on urban and rural county subgroups to examine geographic differences in ACO adoption. Practice participation in ACOs grew 19% nationally from 5.4% to 6.4% of practices between 2015 to 2017, but participation lagged in the West and rural counties, the latter of which had relatively concentrated physician markets and low MA penetration. After controlling for urban location, population density, and other covariates, ACO presence in a county was independently associated with less concentrated physician markets and moderate MA penetration but not commercial insurance concentration. The evidence suggests that Medicare ACO programs have continued appeal to physician practices, but additional engagement strategies may be needed to expand adoption in rural areas. In addition, greater practice competition and MA experience may facilitate ACO adoption. These insights into the relationship between market conditions and ACO participation have important implications for policy efforts to accelerate Medicare payment transformation.
医疗保险责任制医疗组织（ACO）已经实现了高质量的绩效和近期的成本节约，但对于当地市场条件如何影响提供者的采用知之甚少。作者描述了县级医疗保险 ACO 中医生执业的参与情况，并使用调整后的逻辑回归来评估 ACO 存在与 3 个被假设为影响 ACO 形成的特征之间的关联：医生市场集中程度、医疗保险优势（MA）渗透度以及商业健康保险市场集中程度。在城市和农村县亚组中重复分析，以检查 ACO 采用的地理差异。ACO 参与在全国范围内从 2015 年至 2017 年的 5.4%增长到 6.4%，增长了 19%，但在西部和农村县滞后，后者的医生市场相对集中，MA 渗透率较低。在控制城市位置、人口密度和其他协变量后，该县的 ACO 存在与医生市场的集中程度较低和 MA 适度渗透有关，但与商业保险的集中程度无关。证据表明，医疗保险 ACO 计划继续吸引医生执业，但可能需要额外的参与策略来扩大农村地区的采用。此外，更多的实践竞争和 MA 经验可能会促进 ACO 的采用。这些对市场条件与 ACO 参与之间关系的见解，对于加快医疗保险支付转型的政策努力具有重要意义。
