Using a home time measure to differentiate ACO performance for seriously ill populations
Background Alternative Payment Models (APMs) piloted by the Centers for Medicare and Medicaid Services (CMS) such as ACO Realizing Equity, Access and Community Health (REACH) seek to improve care and quality of life among seriously ill populations (SIP). Days at Home (DAH) was proposed for use in th...
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Published in | Journal of the American Geriatrics Society (JAGS) Vol. 70; no. 9; pp. 2666 - 2676 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, USA
John Wiley & Sons, Inc
01.09.2022
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Alternative Payment Models (APMs) piloted by the Centers for Medicare and Medicaid Services (CMS) such as ACO Realizing Equity, Access and Community Health (REACH) seek to improve care and quality of life among seriously ill populations (SIP). Days at Home (DAH) was proposed for use in this model to evaluate organizational performance. It is important to assess the utility and feasibility of person‐centered outcomes measures, such as DAH, as CMS seeks to advance care models for seriously ill beneficiaries. We leverage existing Accountable Care Organization (ACO) contracts to evaluate the feasibility of ACO‐level DAH measure and examine characteristics associated with ACOs with more DAH.
Methods
We calculated DAH for Medicare fee‐for‐service beneficiaries aged 68 and over who were retrospectively attributed to a Medicare ACO between 2014 and 2018 and met the seriously ill criteria. We then aggregated to the ACO level DAH for each ACO's seriously ill beneficiaries and risk‐adjusted this aggregated measure. Finally, we evaluated associations between risk‐adjusted DAH per person‐year and ACO, beneficiary, and market characteristics.
Results
ACOs' seriously ill beneficiaries spent an average of 349.3 risk‐adjusted DAH per person‐year. Risk‐adjusted ACO variation, defined as the interquartile range, was 4.21 days (IQR = 347.32–351.53). Beneficiaries of ACOs are composed of a less racially diverse beneficiary cohort, opting for two‐sided risk models, and operating in markets with fewer hospital and Skilled Nursing Facility beds had more DAH.
Conclusions
Substantial variation across ACOs in the DAH measure for seriously ill beneficiaries suggests the measure can differentiate between high and low performing provider groups. Key to the success of the metric is accurate risk adjustment to ensure providers have adequate resources to care for seriously ill beneficiaries. Organizational factors, such as the ACO size and level of risk, are strongly associated with more days at home.
See related article by Shen et al and editorial by Ankuda et al. in this issue. |
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Bibliography: | Funding information See related article by and editorial by Shen et al Ankuda et al in this issue. West Health Policy Institute ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0002-8614 1532-5415 |
DOI: | 10.1111/jgs.17882 |