Post-acute care is one of the fastest growing areas of US healthcare spending. About 40% of older Americans discharged from a hospital utilize post-acute care, and spending in this area has more than doubled in the past decade. To hold providers responsible for longitudinal care, Medicare is testing accountable care organizations (ACOs) in two pilot programs: the Medicare Shared Savings Program (MSSP) and the Pioneer ACO program. The impact of these efforts on both Medicare spending and patient outcomes remains uncertain, however. To the extent that post-acute care (PAC) spending is reduced, understanding whether lower costs occur through reductions in the quantity or intensity of post-acute care, or both, will be important. Furthermore, ACOs vary widely in their organizational structure and risk models (e.g., stronger vs. weaker PAC engagement; and more vs. less risk-sharing). The magnitude of any changes in PAC utilization will plausibly be modified by ACO heterogeneity. Apart from the effects of ACOs on post-acute care utilization and spending, there is also considerable uncertainty about how any changes in post-acute care will impact key clinical outcomes such as mortality. Therefore, we propose to use national Medicare data to carry out three aims: 1) To evaluate the impact of ACOs on post-acute care spending and utilization; 2) To describe how ACO heterogeneity modifies ACOs? effects on post-acute care spending; and 3) To evaluate the impact of changes in post- acute care spending and utilization on patient outcomes.

Public Health Relevance

Post-acute care is one of the most rapidly growing areas of US healthcare spending. In an effort to improve longitudinal care coordination and restrain rising costs, Medicare is testing accountable care organizations (ACOs). The impact of ACOs on both Medicare spending and patient outcomes remains uncertain, however. To the extent that post-acute care spending is reduced, understanding whether lower costs occur through reductions in the quantity or intensity of post-acute care, or both, will be important. Furthermore, ACOs vary widely in their organizational structure and risk models. Thus, identifying whether ACO heterogeneity modifies ACOs' impact on post-acute care will also be important. Finally, there is considerable uncertainty about how any changes in post-acute care utilization will impact key clinical outcomes such as mortality. Therefore, we propose to use national Medicare data to examine the effects of Medicare ACO implementation on post-acute care utilization, spending, and patient outcomes.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS024698-01
Application #
9153106
Study Section
Healthcare Systems and Values Research (HSVR)
Program Officer
Hellinger, Fred
Project Start
2016-09-30
Project End
2021-07-31
Budget Start
2016-09-30
Budget End
2017-07-31
Support Year
1
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Chen, Lena M; Ryan, Andrew M; Shih, Terry et al. (2018) Medicare's Acute Care Episode Demonstration: Effects of Bundled Payments on Costs and Quality of Surgical Care. Health Serv Res 53:632-648
Holmgren, A Jay; Adler-Milstein, Julia; Chen, Lena M (2018) Participation in a Voluntary Bundled Payment Program by Organizations Providing Care After an Acute Hospitalization. JAMA 320:402-404
Regenbogen, Scott E; Cain-Nielsen, Anne H; Norton, Edward C et al. (2017) Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults. JAMA Surg 152:e170123
Markovitz, Adam A; Ellimoottil, Chandy; Sukul, Devraj et al. (2017) Risk Adjustment May Lessen Penalties On Hospitals Treating Complex Cardiac Patients Under Medicare's Bundled Payments. Health Aff (Millwood) 36:2165-2174
Chen, Lena M; Epstein, Arnold M; Orav, E John et al. (2017) Association of Practice-Level Social and Medical Risk With Performance in the Medicare Physician Value-Based Payment Modifier Program. JAMA 318:453-461