ArticleThe American journal of managed care2018
Changes in specialty care use and leakage in Medicare accountable care organizations.
Article in The American journal of managed care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
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The trial behind it
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Who cites it
13 citing papers in PubMed.
- The effect of dementia on patterns of healthcare use in older adults with diabetes.Journal of the American Geriatrics Society · 2024Article
- Population turnover and leakage in commercial ACOs.The American journal of managed care · 2023Article
- Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol.Frontiers in public health · 2021Article
- Hospitals Strengthened Relationships With Close Partners After Joining Accountable Care Organizations.Medical care research and review : MCRR · 2020Article
- Association between specialist compensation and Accountable Care Organization performance.Health services research · 2020Article
- A Comparison of Health Care Expenditures for Medicaid-Insured Children with Autism Spectrum Disorder and Asthma in an Expanding Accountable Care Organization.Journal of autism and developmental disorders · 2020Article
- Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs.Health affairs (Project Hope) · 2020Article
- Sharing information electronically with other hospitals is associated with increased sharing of patients.Health services research · 2020Article
- Association Between Specialist Office Visits and Health Expenditures in Accountable Care Organizations.JAMA network open · 2019Article
- Patients' and Providers' Views on Causes and Consequences of Healthcare Fragmentation in the Ambulatory Setting: a Qualitative Study.Journal of general internal medicine · 2019Article
- Medicare Spending after 3 Years of the Medicare Shared Savings Program.The New England journal of medicine · 2018Article
- The Effect of Network-Level Payment Models on Care Network Performance: A Scoping Review of the Empirical Literature.International journal of integrated careArticle
- The Role of Medicare Alternative Payment Models in Supporting the Essential Features of Primary Care.Journal of the American Board of Family Medicine : JABFMArticle
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
objectivesReducing leakage to outside specialists has been promoted as a key strategy for accountable care organizations (ACOs). We sought to examine changes in specialty care leakage and use associated with the Medicare Shared Savings Program (MSSP). STUDY
designAnalyses of trends in ACOs from 2010 to 2014 and quasi-experimental difference-in-differences analyses comparing changes for ACOs versus local non-ACO providers from before until after the start of ACO contracts, stratified by ACO specialty composition and year of MSSP entry.
methodsWe used Medicare claims for a 20% sample of beneficiaries attributed to ACOs or non-ACO providers. The main beneficiary-level outcome was the annual count of new specialist visits. ACO-level outcomes included the proportion of visits for ACO-attributed patients outside of the ACO (leakage) and proportion of ACO Medicare outpatient revenue devoted to ACO-attributed patients (contract penetration).
resultsLeakage of specialist visits decreased minimally from 2010 to 2014 among ACOs. Contract penetration also changed minimally but differed substantially by specialty composition (85% for the most primary care-oriented quartile vs 47% for the most specialty-oriented quartile). For the most primary care-oriented quartile of ACOs in 2 of 3 entry cohorts, MSSP participation was associated with differential reductions in new specialist visits (-0.04 visits/beneficiary in 2014 for the 2012 cohort; -5.4%; P <.001). For more specialty-oriented ACOs, differential changes in specialist visits were not statistically significant.
conclusionsLeakage of specialty care changed minimally in the MSSP, suggesting ineffective efforts to reduce leakage. MSSP participation was associated with decreases in new specialty visits among primary care-oriented ACOs.
Indexed as
Identifiers
29851445PMC5986093What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.