TY - JOUR
T1 - Factors That Distinguish High-Performing Accountable Care Organizations in the Medicare Shared Savings Program
AU - D'Aunno, Thomas
AU - Broffman, Lauren
AU - Sparer, Michael
AU - Kumar, Sumit R.
N1 - Funding Information:
Joint Acknowledgment/Disclosure Statement: Authors reports grants from Universal American Insurance Co., during the conduct of the study; and readers could possibly perceive that Universal American (UA) could influence the results (i.e., the appearance of potentially influencing the paper) because they paid us to do the study, which examines organizations (ACOs) that UA founded. Yet UA signed a standard contract with Columbia University that gives us total control of the project, including the right to publish the results without interference. Further, the Columbia University Institutional Review Board (IRB) approved the study. Disclosures: None. Disclaimers: None.
Publisher Copyright:
© Health Research and Educational Trust
PY - 2018/2
Y1 - 2018/2
N2 - Objective: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program. Data Sources/Study Setting: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs. Study Design: Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance. Data Collection Methods: A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed. Principal Findings: Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators. Conclusions: Shorter interventions can improve ACO performance—use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician–hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance.
AB - Objective: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program. Data Sources/Study Setting: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs. Study Design: Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance. Data Collection Methods: A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed. Principal Findings: Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators. Conclusions: Shorter interventions can improve ACO performance—use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician–hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance.
KW - Accountable care organizations
KW - Patient Protection and Affordable Care Act
KW - physician leadership
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U2 - 10.1111/1475-6773.12642
DO - 10.1111/1475-6773.12642
M3 - Article
C2 - 28024312
AN - SCOPUS:85007297510
SN - 0017-9124
VL - 53
SP - 120
EP - 137
JO - Health Services Research
JF - Health Services Research
IS - 1
ER -