Because there are typically multiple payers for a particular provider’s patient population, there can be spillover effects from the policies of one payer to the others. An article in the Journal of the American Medical Association explores whether providers who have an accountable care organization arrangement with a commercial payer show any spillover effects to their Medicare beneficiary population. (JAMA Article) Spillover effects could be positive or negative. Better process quality and utilization control in one population might be copied in others, or a loss of revenue might be made up by more utilization in the other populations. In the research at issue, provider groups in Massachusetts had ACO contracts with the local Blue Cross plan and under those contracts the providers were paid more for hitting quality targets and were at financial risk for global spending. Early results showed that spending was reduced, particularly in the outpatient categories. The researchers compared spending and utilization for Medicare beneficiaries served by the 7 provider groups doing the commercial ACO business versus spending and utilization for beneficiaries not served by these providers. The analysis showed that there was lower spending for the Medicare population served by the providers with ACO contracts, with the savings also concentrated among complex patients and in outpatient categories such as testing, imaging and procedures. Savings increased in the second year of the study. There were, however, only minimal improvements in quality of care measures for the Medicare beneficiaries; less so than for the commercial ACO population. But it is encouraging to see that one large payer who creates incentives for providers to be more cost-conscious can have a broader impact.
Medicare Spillover Effects from a Commercial ACO
No Comments
✅ Subscribe via Email
About this Blog
Healthy Skeptic Podcast
Research
MedPAC 2019 Report to Congress
June 18, 2019
Headlines
Tags
Access
ACO
Care Management
Chronic Disease
Comparative Effectiveness
Consumer Directed Health
Consumers
Devices
Disease Management
Drugs
EHRs
Elder Care
End-of-Life Care
FDA
Financings
Genomics
Government
Health Care Costs
Health Care Quality
Health Care Reform
Health Insurance
Health Insurance Exchange
HIT
HomeCare
Hospital
Hospital Readmissions
Legislation
M&A
Malpractice
Meaningful Use
Medicaid
Medical Care
Medicare
Medicare Advantage
Mobile
Pay For Performance
Pharmaceutical
Physicians
Providers
Regulation
Repealing Reform
Telehealth
Telemedicine
Wellness and Prevention
Workplace
Related Posts
Commentary
October 4, 2023
Electric Cars for Everyone, so Rich People Can Get Richer
Everything about electric cars is expensive, including insurance, but rich people get richer from them.
Commentary
October 3, 2023
Minnesota’s Modeling Nightmare
Minnesota finally wants to figure out how epidemic modeling was so bad, but the Strib…
Commentary
October 3, 2023
Reality Intrudes Again on the Renewable Energy Delusion
Solar and wind power are the most expensive forms of electricity and the cost of…