Association of Pioneer Accountable Care Organizations vs Traditional Medicare Fee for Service With Spending, Utilization, and Patient Experience

摘要: Importance The Pioneer Accountable Care Organization (ACO) Model aims to drive health care organizations reduce expenditures while improving quality for fee-for-service (FFS) Medicare beneficiaries. Objective To determine whether FFS beneficiaries aligned with ACOs had smaller increases in spending and utilization than other retaining similar levels of satisfaction the first 2 years ACO Model. Design, Setting, Participants were 32 (n = 675 712 2012; n = 806 258 2013) a comparison group alignment-eligible same markets (n = 13 203 694 n = 12 134 154 2013). Analyses comprised difference-in-differences multivariable regression Oaxaca-Blinder reweighting model expenditure outcomes over 2-year performance period (2012-2013) baseline (2010-2011) as well adjusted analyses Consumer Assessment Healthcare Providers & Systems (CAHPS) survey responses among random samples (n = 13 097), (n = 116 255), or Advantage (n = 203 736) 2012 care. Exposures Beneficiary alignment 2013. Main Outcomes Measures spending, utilization, CAHPS domain scores. Results Total 2013 increased from lesser degree relative populations. Differential changes approximately −$35.62 (95% CI, −$40.12 −$31.12) per-beneficiary-per-month (PBPM) -$11.18 −$15.84 −$6.51) PBPM 2013, which amounted aggregate reductions −$280 −$315 −$244) million −$105 −$148 −$61) Inpatient showed largest differential change any category (−$14.40 [95% −$17.31 −$11.49] −$6.46 −$9.26 −$3.66] Changes physician services, emergency department, postacute followed pattern. Compared beneficiaries, ACO-aligned reported higher mean scores timely (77.2 [ACO] vs 71.2 [FFS] 72.7 [MA]) clinician communication (91.9 88.3 88.7 [MA]). Conclusions Relevance In Model, ACOs, compared general exhibited total different little difference patient experience.