Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO

• Published in: Health Affairs Vol. 36; no. 5; pp. 876 - 884
• Main Authors: Hsu, John, Price, Mary, Vogeli, Christine, Brand, Richard, Chernew, Michael E, Chaguturu, Sreekanth K, Weil, Eric, Ferris, Timothy G
• Format: Journal Article
• Language: English
• Published: United States The People to People Health Foundation, Inc., Project HOPE 01.05.2017
• Subjects: Accountability; Accountable care organizations; Accountable Care Organizations - economics; Aged; Beneficiaries; Cost control; Cost Savings; Delivery of Health Care - economics; Delivery of Health Care - methods; Emergency management; Emergency medical care; Emergency medical services; Emergency services; Estimates; Female; Government programs; Health care; Health care expenditures; Health care industry; Health care management; Health care policy; Health Expenditures; Hospitalization; Humans; Intervention; Male; Managed Care Programs; Management; Medicare; Medicare - economics; Organizations; Participation; Patient participation; Patients; Physicians; Primary care; Risk factors; United States; Visits; Medicare care management programs; Accountable Care Organizations; medical spending
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2016.0922

Accountable care organizations (ACOs) appear to lower medical spending, but there is little information on how they do so. We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009-14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects. The care management program (the ACO's primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associated with substantial reductions in rates for hospitalizations and both all and nonemergency ED visits, as well as Medicare spending, when compared to preparticipation levels and to rates and spending for a concurrent sample of beneficiaries who were eligible for but had not yet started the program. Rates of ED visits and hospitalizations were reduced by 6 percent and 8 percent, respectively, and Medicare spending was reduced by 6 percent. Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs.