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The association between care management and outcomes in Medicare ACOs

As they have become more widespread, ACOs have employed a variety of care management and coordination strategies.

Jeff Lagasse, Associate Editor

A new study from The Dartmouth Institute for Health Policy and Clinical Practice, published this week in JAMA Network Open, finds that Accountable Care Organization-reported care management and coordination activities were not associated with improved outcomes or lower spending for patients with complex needs.

Patients with complex medical and social needs -- such as older adults who are frail or suffer from multiple chronic conditions -- often experience difficulty navigating the healthcare system since their care is typically fragmented across many practitioners and settings. As a result, gaps in the quality of their care and unnecessary spending occur, contributing to a disproportionate amount of Medicare-associated costs.

As they have become more widespread in healthcare, ACOs have employed a variety of care management and coordination strategies to address these issues.


To determine the impact these strategies have on improving patient outcomes and reducing healthcare costs, the researchers conducted a cross-sectional study using Medicare claims data and the National Survey of Accountable Care Organizations that included surveys from 244 Medicare Shared Savings Program ACOs.

In their analysis, the team looked at more than 1.4 million Medicare beneficiaries with complex health and social needs. They computed an index score -- grouping patients by intensity of services -- that measured self-reported care management and coordination activity that was then linked to Medicare claims. The primary outcomes of interest included quality of care, healthcare utilization, spending and interactions with the healthcare system.

While the care management and coordination activities that were reported by ACOs were not associated with differences in spending or measured outcomes for this population of patients, the study's limitations should be considered when interpreting the results, the authors said.

The most important limitation is its cross-sectional nature, which doesn't allow for the analysis of actual causation. A longitudinal analysis would allow researchers to determine whether length of exposure to care management affects health outcomes.

Future efforts to care for patients with complex needs should assess whether strategies that are effective in other settings are being used, and if so, why they fail to meet expectations, they said.


It's been roughly six months since CMS issued the final rule for the overhaul of ACO payments.

The rule stipulates that to remain an ACO, the organizations will be required to assume risk sooner, ending the six-year period in which ACOs can stay in an upside-only risk model. The rule, which governs the Medicare Shared Savings Program, is expected to save Medicare about $2.9 billion over 10 years.

Twitter: @JELagasse

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