TY - JOUR
KW - Accountable Care Organizations/economics/organization & administration
KW - Centers for Medicare and Medicaid Services (U.S.)/statistics & numerical data
KW - Continuity of Patient Care/organization & administration
KW - Cost Savings/economics
KW - Cost-Benefit Analysis
KW - Fee-for-Service Plans/organization & administration
KW - Markov Chains
KW - Models, Econometric
KW - Quality of Health Care/economics/organization & administration
KW - United States
KW - accountable care organization
KW - Cost-benefit
KW - fee-for-service
KW - Performance
KW - quality
AU - S. Parasrampuria
AU - A. H. Oakes
AU - S. S. Wu
AU - M. A. Parikh
AU - W. V. Padula
A1 - 
AB - OBJECTIVES: Determine the relationship between quality of an accountable care organization (ACO) and its long-term reduction in healthcare costs. METHODS: We conducted a cost minimization analysis. Using Centers for Medicare and Medicaid cost and quality data, we calculated weighted composite quality scores for each ACO and organization-level cost savings. We used Markov modeling to compute the probability that an ACO transitioned between different quality levels in successive years. Considering a health-systems perspective with costs discounted at 3 percent, we conducted 10,000 Monte Carlo simulations to project long-term cost savings by quality level over a 10-year period. We compared the change in per-member expenditures of Pioneer (early-adopters) ACOs versus Medicare Shared Savings Program (MSSP) ACOs to assess the impact of coordination of care, the main mechanism for cost savings. RESULTS: Overall, Pioneer ACOs saved USD 641.24 per beneficiary and MSSP ACOs saved USD 535.59 per beneficiary. By quality level: (a) high quality organizations saved the most money (Pioneer: USD 459; MSSP: USD 816); (b) medium quality saved some money (Pioneer: USD 222; MSSP: USD 105); and (c) low quality suffered financial losses (Pioneer: USD -40; MSSP: USD -386). CONCLUSIONS: Within the existing fee-for-service healthcare model, ACOs are a mechanism for decreasing costs by improving quality of care. Higher quality organizations incorporate greater levels of coordination of care, which is associated with greater cost savings. Pioneer ACOs have the highest level of integration of services; hence, they save the most money.
AD - Department of Health Policy & Management,Johns Hopkins Bloomberg School of Public Health.; Department of Health Policy & Management,Johns Hopkins Bloomberg School of Public Health.; Department of Health Policy & Management,Johns Hopkins Bloomberg School of Public Health.; Department of Health Policy & Management,Johns Hopkins Bloomberg School of Public Health.; Department of Health Policy & Management,Johns Hopkins Bloomberg School of Public Healthwpadula@jhu.edu.
BT - International Journal of Technology Assessment in Health Care
C5 - Financing & Sustainability
CP - 4
CY - England
DO - 10.1017/S0266462318000399
IS - 4
JF - International Journal of Technology Assessment in Health Care
M1 - Journal Article
N2 - OBJECTIVES: Determine the relationship between quality of an accountable care organization (ACO) and its long-term reduction in healthcare costs. METHODS: We conducted a cost minimization analysis. Using Centers for Medicare and Medicaid cost and quality data, we calculated weighted composite quality scores for each ACO and organization-level cost savings. We used Markov modeling to compute the probability that an ACO transitioned between different quality levels in successive years. Considering a health-systems perspective with costs discounted at 3 percent, we conducted 10,000 Monte Carlo simulations to project long-term cost savings by quality level over a 10-year period. We compared the change in per-member expenditures of Pioneer (early-adopters) ACOs versus Medicare Shared Savings Program (MSSP) ACOs to assess the impact of coordination of care, the main mechanism for cost savings. RESULTS: Overall, Pioneer ACOs saved USD 641.24 per beneficiary and MSSP ACOs saved USD 535.59 per beneficiary. By quality level: (a) high quality organizations saved the most money (Pioneer: USD 459; MSSP: USD 816); (b) medium quality saved some money (Pioneer: USD 222; MSSP: USD 105); and (c) low quality suffered financial losses (Pioneer: USD -40; MSSP: USD -386). CONCLUSIONS: Within the existing fee-for-service healthcare model, ACOs are a mechanism for decreasing costs by improving quality of care. Higher quality organizations incorporate greater levels of coordination of care, which is associated with greater cost savings. Pioneer ACOs have the highest level of integration of services; hence, they save the most money.
PP - England
PY - 2018
SN - 1471-6348; 0266-4623
SP - 388
EP - 392
EP - 
T1 - Value and Performance of Accountable Care Organizations: a Cost-Minimization Analysis
T2 - International Journal of Technology Assessment in Health Care
TI - Value and Performance of Accountable Care Organizations: a Cost-Minimization Analysis
U1 - Financing & Sustainability
U2 - 29991357
U3 - 10.1017/S0266462318000399
VL - 34
VO - 1471-6348; 0266-4623
Y1 - 2018
Y2 - Jan
ER -