Accountable Care Organizations (ACOs) are groups of health
care providers, including doctors, hospitals, and other service providers, who provide coordinated care, reducing the need for patients to manage coordination of their own care. These organizations receive incentives from Medicare when they deliver care to patients efficiently. Providers make more money if they keep their patients healthy. Medicare and private sector ACOs now cover approximately 23.5 million people in the United States. Kaiser Health News created a great video explaining the ABCs of ACOs that’s worth your time if you’re looking for more detailed information.
The use of ACOs was included in the Affordable Care Act as a means of reducing costs in Medicare and improving health outcomes. However, results to date are mixed on whether or not the program is achieving its intended goal.
An article in the March issue of Medical Care reported on the association of preventive care quality performance with organizational characteristics of ACOs. The authors combined several measures of preventive care quality from Centers for Medicare and Medicaid Services (CMS) data, creating composite measures to assess these relationships. To measure organizational characteristics, they used data from the National Survey of ACOs.
Five composite ACO characteristics were measured:
- Beneficiary composition
- Provider composition
- General characteristics
- Electronic health record (EHR) capabilities
- Quality management capabilities
Preventive care quality performance was distilled into two overarching categories from eight available measures using exploratory factor analysis:
- Disease prevention
- Wellness screening
Key findings:
- Better performance on both quality measures was associated with higher ratios of ACO beneficiaries to primary care provider (PCP), fewer specialists, and participation in the Medicare Advanced Payment Model.
- Additionally, better outcomes in disease prevention were associated with having a hospital in the ACO, a bigger primary care workforce, and increased EHR capabilities.
The finding of increased quality as the ratio of patient to PCP increases is interesting as one might expect a smaller ratio to lead to better outcomes. However, the authors suggest that this relationship is likely due to PCPs gaining more experience with the larger patient population and an increased focus on an ACO’s quality measures because of the larger number of PCPs.
Nathaniel Taylor