Jamakandi Shriya, Li Joan, Chien Alyna T, Alcusky Matthew, Kerrissey Michaela
Department of Health Services Policy & Practice (HSPP) (S Jamakandi), Brown University School of Public Health, Providence, RI.
Division of General Pediatrics (J Li and AT Chien), Boston Children's Hospital, Boston, Mass.
Acad Pediatr. 2025 May-Jun;25(4):102601. doi: 10.1016/j.acap.2024.102601. Epub 2024 Nov 5.
To examine the experience of Medicaid Accountable Care Organizations (ACOs) that include pediatric practices, including their motivations and experiences working together.
This mixed-methods study is set within the first 2 years of the Massachusetts Medicaid ACO Program, which created 17 Medicaid ACOs across the Commonwealth in 2018. It combines qualitative interviews from organizational leaders across 3 Medicaid ACOs with pediatric representation (N = 28; purposive sample; 2018) with a 44-item primary care practice leader survey (N = 225 after 64% response rate; statewide stratified random sample of primary care practices; 2019). Interviews gathered information about organizational motivations and experiences with becoming a Medicaid ACO; the survey asked 5 domains of questions describing the experience of pediatric- and adult-focused primary care practices in joining Medicaid ACOs (eg, how much practices solved problems jointly with the ACO). We used ordinary least squares regression to describe differences in experiences across pediatric versus nonpediatric practices.
Leaders of Medicaid ACOs with pediatric representation expressed a desire to voice pediatric concerns regarding state Medicaid payment policy and to integrate social services as part of routine medical care. Relative to the experience of adult-focused primary care practice leaders, pediatric-focused practices reported less collaboration within the Medicaid ACO (95% confidence interval 0.81-0.05; P = 0.03) and less change toward standardization of policies such as physician compensation (95% confidence interval 0.61-0.02; P = 0.04).
Initial Medicaid ACO experiences can differ based on the degree to which organizations joining Medicaid ACO programs serve pediatric populations.
考察纳入儿科医疗业务的医疗补助责任医疗组织（ACO）的经验，包括其合作动机及经历。
这项混合方法研究开展于马萨诸塞州医疗补助ACO项目的头两年，该项目于2018年在全州创建了17个医疗补助ACO。研究将来自3个有儿科代表参与的医疗补助ACO的组织领导者的定性访谈（N = 28；目的抽样；2018年）与一项有44个项目的初级医疗业务领导者调查（回复率64%后N = 225；全州初级医疗业务分层随机样本；2019年）相结合。访谈收集了关于组织成为医疗补助ACO的动机及经历的信息；调查询问了5个领域的问题，描述了专注于儿科和成人的初级医疗业务加入医疗补助ACO的经历（例如，各业务与ACO共同解决问题的程度）。我们使用普通最小二乘法回归来描述儿科与非儿科业务在经历上的差异。
有儿科代表参与的医疗补助ACO的领导者表示，希望表达儿科对州医疗补助支付政策的关切，并将社会服务纳入常规医疗护理。相对于专注于成人的初级医疗业务领导者的经历，专注于儿科的业务在医疗补助ACO内部的协作较少（95%置信区间0.81 - 0.05；P = 0.03），在诸如医生薪酬等政策标准化方面的变化也较少（95%置信区间0.61 - 0.02；P = 0.04）。
医疗补助ACO的初始经验可能因加入医疗补助ACO项目的组织服务儿科人群的程度不同而有所差异。
