Lower Post-Acute Spending Associated with Medicare Shared Savings

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In addition, performance was similar on standardized costs for Oregon and Colorado Medicaid ACO models.
In addition, performance was similar on standardized costs for Oregon and Colorado Medicaid ACO models.

HealthDay News -- According to two studies published in JAMA Internal Medicine, participation in the Medicare Shared Savings Program (MSSP) is associated with an overall reduction in post-acute spending. In addition, the performance of Oregon's Medicaid Accountable Care Organization (ACO) model is similar to that of Colorado.

J Michael McWilliams, MD, PhD, from Harvard Medical School in Boston, and colleagues examined changes in post-acute care spending and use of post-acute care associated with provider participation in ACOs in the MSSP. 

The researchers found that for the 2012 cohort of 114 ACOs, MSSP participation correlated with an overall decline in post-acute spending; this was driven by reductions in acute inpatient care, discharges to facilities versus home, and length of stay in a skilled nursing facility.

K John McConnell, PhD, from the Oregon Health & Science University in Portland, and colleagues compared the performance of Oregon's and Colorado's Medicaid ACO models. The researchers found that in both states, standardized expenditures for selected services decreased during 2010 to 2014; these reductions did not differ significantly between the states. 

There were reductions in emergency department and primary care visits, and improvements in acute preventable hospital admissions, 3 of 4 measures of access, adolescent well-care visits, adult access to preventive ambulatory care, and in 1 of 4 measures of appropriateness of care with Oregon's model.

"Oregon's model, marked by a large federal investment and movement to global budgets, was associated with improvements in some measures of utilization, access, and quality, but Colorado's model paralleled Oregon's on several other metrics," the authors write.

One author from the McWilliams study reported serving as an expert witness for the Federal Trade Commission, and two authors disclosed financial ties to the health care industry.

References

McWilliams JM, et al. "Changes in Post-acute Care in the Medicare Shared Savings Program." JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2016.9115. [Epub ahead of print]

McConnell KJ, et al. "Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado." JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2016.9098. [Epub ahead of print]

Colla CH and Fisher ES. "Moving Forward With Accountable Care Organizations: Some Answers, More Questions." JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2016.9122. [Epub ahead of print]

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