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Michael J Mcwilliams - One of the best experts on this subject based on the ideXlab platform.
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early effects of an Accountable Care Organization model for underserved areas
The New England Journal of Medicine, 2019Co-Authors: Matthew J Trombley, Betty Fout, Sasha Brodsky, Michael J Mcwilliams, David J Nyweide, Brant MorefieldAbstract:Abstract Background The Centers for MediCare and Medicaid Services (CMS) developed the Accountable Care Organization (ACO) Investment Model (AIM) to encourage the growth of MediCare Shared Savings ...
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association of changes in medication use and adherence with Accountable Care Organization exposure in patients with cardiovascular disease or diabetes
JAMA Cardiology, 2017Co-Authors: Michael J Mcwilliams, Mehdi Najafzadeh, William H Shrank, Jennifer M PolinskiAbstract:Importance Many of the quality measures used to assess Accountable Care Organization (ACO) performance in the MediCare Shared Savings Program (MSSP) focus on disease control and medication use among patients with cardiovascular disease and diabetes. To date, the association between participation in the MSSP by provider Organizations and medication use or adherence among their patients with cardiovascular disease or diabetes has not been described. Objective To assess the association between exposure to the MSSP and changes in the use of and adherence to common antihypertensive, lipid-lowering, and hypoglycemic medications. Design, Setting, and Participants Fee-for-service MediCare claims from January 1, 2009, to December 31, 2014, were used to conduct difference-in-differences comparisons of changes for ACO-attributed beneficiaries from before the start of ACO contracts to 2014 with concurrent changes for beneficiaries attributed to local non-ACO providers (control group). A random 20% sample of MediCare beneficiaries contributing 4 482 168 to 10 849 224 beneficiary-years for analysis from 2009 to 2014, depending on the drug class, was examined. Differential changes were estimated separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. Data analysis was conducted from November 1, 2016, to April 5, 2017. Exposures Patient attribution to an ACO after entry into the MSSP. Main Outcomes and Measures Any use (at least 1 prescription fill) and proportion of days covered (PDC), a standard claims-based measure of adherence, assessed for each of 6 drug classes: statins, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, β-blockers, thiazide diuretics, calcium channel blockers, and metformin. Results Differences in patient characteristics between the MSSP and control group were generally small after geographic adjustment and changed minimally from the precontract period to 2014. There were no significant differential changes in medication use from the precontract period to 2014 for any cohort of MSSP ACOs in any drug class, except for a slight differential increase in the use of thiazides among beneficiaries with hypertension in the 2013 entry cohort (adjusted differential change, 0.5 percentage point; 95% CI, 0.1-0.8 percentage points; or 1.5% of the overall percentage using thiazides [33.4%], P = .01). Similarly, there were no significant differential changes in PDC among beneficiaries with at least 1 prescription fill, except for slight differential increases in the PDC for β-blockers in the 2012 entry cohort (adjusted differential change, 0.3 percentage point; 95% CI, 0.1-0.5 percentage points; or 0.4% of the mean PDC [82.3%], P = .003) and for metformin in the 2012 and 2013 cohorts (adjusted differential change, 0.5 percentage point; 95% CI, 0.1-0.9 percentage points; or 0.6% of the mean PDC [78.2%], P = .01 for both). Conclusions and Relevance Exposure to the MSSP has not been associated with meaningful changes in medication use or adherence among patients with cardiovascular disease and diabetes.
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variation in Accountable Care Organization spending and sensitivity to risk adjustment implications for benchmarking
Health Affairs, 2016Co-Authors: Sherri Rose, Alan M Zaslavsky, Michael J McwilliamsAbstract:Spending targets (or benchmarks) for Accountable Care Organizations (ACOs) participating in the MediCare Shared Savings Program must be set Carefully to encourage program participation while achiev...
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variation in Accountable Care Organization spending and sensitivity to risk adjustment implications for benchmarking
Health Affairs, 2016Co-Authors: Sherri Rose, Alan M Zaslavsky, Michael J McwilliamsAbstract:Spending targets (or benchmarks) for Accountable Care Organizations (ACOs) participating in the MediCare Shared Savings Program must be set Carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in Care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients.
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changes in low value services in year 1 of the mediCare pioneer Accountable Care Organization program
JAMA Internal Medicine, 2015Co-Authors: Aaron L Schwartz, Michael E Chernew, Michael J Mcwilliams, Bruce E LandonAbstract:Importance Wasteful practices are widespread in the US health Care system. It is unclear if payment models intended to improve health Care efficiency, such as the MediCare Accountable Care Organization (ACO) programs, discourage the provision of low-value services. Objective To assess whether the first year of the MediCare Pioneer ACO program was associated with a reduction in use of low-value services. Design, Setting, and Participants In a difference-in-differences analysis, we compared use of low-value services between MediCare fee-for-service beneficiaries attributed to health Care provider groups that entered the Pioneer program (ACO group) and beneficiaries attributed to other health Care providers (control group) before (2009-2011) vs after (2012) Pioneer ACO contracts began. Data analysis was conducted from December 1, 2014, to June 27, 2015. Comparisons were adjusted for beneficiaries’ sociodemographic and clinical characteristics as well as for geography. We decomposed estimates according to service characteristics (clinical category, price, and sensitivity to patient preferences) and compared estimates between subgroups of ACOs with higher vs lower baseline use of low-value services. Main Outcomes and Measures Use of, and spending on, 31 services in instances that provide minimal clinical benefit, measured as annual service counts per 100 beneficiaries and price-standardized annual service spending per 100 beneficiaries. Results During the precontract period, trends in the use of low-value services were similar for the ACO and control groups. The first year of ACO contracts was associated with a differential reduction (95% CI) of 0.8 low-value services per 100 beneficiaries for the ACO group (−1.2 to −0.4; P P = .004). Differential reductions were similar for services less sensitive vs more sensitive to patient preferences and for higher- vs lower-priced services. The ACOs with higher than their markets’ mean baseline levels of low-value service use experienced greater service reductions (−1.2 services per 100 beneficiaries; −1.7 to −0.7; P P = .41; P = .003 for test of difference between subgroups). Conclusions and Relevance During its first year, the Pioneer ACO program was associated with modest reductions in low-value services, with greater reductions for Organizations providing more low-value Care. Accountable Care Organization–like risk contracts may be able to discourage use of low-value services even without specifying services to target.
Genevieve M Hale - One of the best experts on this subject based on the ideXlab platform.
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integration strategies of pharmacists in primary Care based Accountable Care Organizations a report from the Accountable Care Organization research network services and education
Journal of Managed Care Pharmacy, 2017Co-Authors: Tina Joseph, Genevieve M Hale, Sara M Eltaki, Yesenia Prados, Renee S Jones, Matthew J Seamon, Cynthia Moreau, Stephanie GernantAbstract:BACKGROUND: The Accountable Care Organization (ACO) is an innovative health Care delivery model centered on value-based Care. ACOs consisting of primary Care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal. PROGRAM DESCRIPTION: As experts in medication management, pharmacists perform direct patient Care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient Care. Pharmacist-provided Care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional Care settings, their role has often been overlooked in the primary Care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice facult...
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Acclimating to the Increase in Statin Use in Accountable Care Organizations Based on Changes in Quality Measures: A Report from the Accountable Care Organization Research Network, Services, and Education
Journal of managed care & specialty pharmacy, 2017Co-Authors: Leah Bensimon, Genevieve M HaleAbstract:The Accountable Care Organization Research Network, Services, and Education (ACORN SEED), founded by faculty members at Nova Southeastern University College of Pharmacy, is a group of pharmacists that provides unique pharmacy services to Accountable Care Organizations (ACOs), patient-centered medical homes, and management services Organizations to help maximize shared savings and target medication-related issues, while promoting the pharmacy profession and unique learning experiences for pharmacy students within these settings. In this report, ACORN SEED investigators provide a brief overview of the ACO benchmark measures in relation to statin use. Historically, hyperlipidemia treatment was tailored to meet certain cholesterol levels as a surrogate marker in preventing major adverse cardiovascular events, specifically a low-density lipoprotein cholesterol (LDL-C) level less than 100 mg/dL as a target goal. In addition, MediCare assessed a health Care provider’s performance based on this target goal in spe...
Vahakn B. Shahinian - One of the best experts on this subject based on the ideXlab platform.
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Accountable Care Organizations and Spending for Patients Undergoing Long-Term Dialysis.
Clinical journal of the American Society of Nephrology : CJASN, 2020Co-Authors: Shivani Bakre, John M. Hollingsworth, Phyllis Yan, Emily J. Lawton, Richard A. Hirth, Vahakn B. ShahinianAbstract:Background and objectives Despite representing 1% of the population, beneficiaries on long-term dialysis account for over 7% of MediCare’s fee-for-service spending. Because of their focus on Care coordination, Accountable Care Organizations may be an effective model to reduce spending inefficiencies for this population. We analyzed MediCare data to examine time trends in long-term dialysis beneficiary alignment to Accountable Care Organizations and differences in spending for those who were Accountable Care Organization aligned versus nonaligned. Design, setting, participants, & measurements In this retrospective cohort study, beneficiaries on long-term dialysis between 2009 and 2016 were identified using a 20% random sample of MediCare beneficiaries. Trends in alignment to an Accountable Care Organization were compared with alignment of the general MediCare population from 2012 to 2016. Using an interrupted time series approach, we examined the association between Accountable Care Organization alignment and the primary outcome of total spending for long-term dialysis beneficiaries from prior to Accountable Care Organization implementation (2009–2011) through implementation of the Comprehensive ESRD Care model in October 2015. We fit linear regression models with generalized estimating equations to adjust for patient characteristics. Results During the study period, 135,152 beneficiaries on long-term dialysis were identified. The percentage of long-term dialysis beneficiaries aligned to an Accountable Care Organization increased from 6% to 23% from 2012 to 2016. In the time series analysis, spending on Accountable Care Organization–aligned beneficiaries was $143 (95% confidence interval, $5 to $282) less per beneficiary-quarter than spending for nonaligned beneficiaries. In analyses stratified by whether beneficiaries received Care from a primary Care physician, savings by Accountable Care Organization–aligned beneficiaries were limited to those with Care by a primary Care physician ($235; 95% confidence interval, $73 to $397). Conclusions There was a substantial increase in the percentage of long-term dialysis beneficiaries aligned to an Accountable Care Organization from 2012 to 2016. Moreover, in adjusted models, Accountable Care Organization alignment was associated with modest cost savings among long-term dialysis beneficiaries with Care by a primary Care physician.
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Accountable Care Organizations and Prostate Cancer Care
Urology practice, 2016Co-Authors: Brent K. Hollenbeck, Phyllis Yan, Samuel R. Kaufman, Tudor Borza, Lindsey A. Herrel, David C. Miller, Amy N. Luckenbaugh, Ted A. Skolarus, Vahakn B. ShahinianAbstract:AbstractIntroduction: Accountable Care Organizations have the potential to increase the value of health Care by improving population health and enhancing financial stewardship. How practice context modifies effects on a specialty focused disease, such as prostate cancer Care, has implications for their success.Methods: We performed a retrospective cohort study of newly diagnosed men with prostate cancer between 2012 and 2013 using national MediCare data. Practice affiliation (small single specialty, large single specialty, multispecialty groups) and Accountable Care Organization alignment were measured at the patient level. Generalized linear multivariable models were fitted to derive adjusted rates of treatment and spending for the 12-month period after diagnosis according to Accountable Care Organization alignment and practice affiliation.Results: Of 15,640 patients with newly diagnosed prostate cancer 1,100 (7.0%) were aligned with Accountable Care Organizations. Patients in these Organizations had use...
Allison Kempe - One of the best experts on this subject based on the ideXlab platform.
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randomized controlled trial of centralized vaccine reminder recall to improve adult vaccination rates in an Accountable Care Organization setting
Preventive medicine reports, 2019Co-Authors: Laura P Hurley, Brenda L Beaty, Steven Lockhart, Dennis Gurfinkel, Miriam L Dickinson, Heather Roth, Allison KempeAbstract:Our objectives were to assess 1) effectiveness of using Colorado's Immunization Information System (CIIS) to send out vaccine reminder/recalls (R/Rs) centrally vs. usual Care for adult vaccine delivery within an Accountable Care Organization (ACO) and 2) practice staff's perception of centralized R/R. From 9/2016 to 4/2017, we conducted a randomized controlled trial among adults enrolled in a Medicaid ACO at six healthCare entities. Adults were divided into two strata: 15,153 age 19-64 and 616 age 65+. Adults age 19-64 who needed influenza and/or Tdap vaccine, and adults age 65+ who needed influenza, and/or Tdap, and/or a pneumococcal vaccine were randomized to receive up to 3 R/Rs by autodialed telephone and mail or usual Care. Documentation of receipt of any needed vaccines in CIIS within six months was the primary outcome. We assessed intervention effectiveness using mixed effect logistic regression. Thirteen semi-structured exit interviews were conducted with staff from each healthCare entity. The intervention was not associated with the primary outcome for the age 19-64 population [OR 1.06 (95% CI 0.98-1.15)] or age 65+ population [(OR 0.96 (0.69-1.32)]. Practice staff perceived the intervention to be beneficial and not burdensome. Perceived barriers included lack of availability of appointments and adults receiving only influenza vaccine when other vaccines were needed. In conclusion, centralized R/R was not effective at improving adult vaccination rates in a Medicaid ACO. Future studies should consider better harmonizing vaccine centralized R/Rs with vaccine delivery efforts within the practice setting. Clinical Trials Registration Number: NCT02133391.
Li Wu Chen - One of the best experts on this subject based on the ideXlab platform.
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an examination of multilevel factors influencing colorectal cancer screening in primary Care Accountable Care Organization settings a mixed methods study
Journal of Public Health Management and Practice, 2019Co-Authors: Jungyoon Kim, Hongmei Wang, Lufei Young, Tzeyu L Michaud, Mohammad Siahpush, Paraskevi A Farazi, Li Wu ChenAbstract:OBJECTIVE To identify patient, provider, and delivery system-level factors associated with colorectal cancer (CRC) screening and validate findings across multiple data sets. DESIGN A concurrent mixed-methods design using electronic health records, provider survey, and provider interview. SETTING Eight primary Care Accountable Care Organization clinics in Nebraska. MEASURES Patients' demographic/social characteristics, health utilization behaviors, and perceptions toward CRC screening; provider demographics and practice patterns; and clinics' delivery systems (eg, reminder system). ANALYSIS Quantitative (frequencies, logistic regression, and t tests) and qualitative analyses (thematic coding). RESULTS At the patient level, being 65 years of age and older (odds ratio [OR] = 1.34, P < .001), being non-Hispanic white (OR = 1.93, P < .001), having insurance (OR = 1.90, P = .01), having an annual physical examination (OR = 2.36, P < .001), and having chronic conditions (OR = 1.65 for 1-2 conditions, P < .001) were associated positively with screening, compared with their counterparts. The top 5 patient-level barriers included discomfort/pain of the procedure (60.3%), finance/cost (57.4%), other priority health issues (39.7%), lack of awareness (36.8%), and health literacy (26.5%). At the provider level, being female (OR = 1.88, P < .001), having medical doctor credentials (OR = 3.05, P < .001), and having a daily patient load less than 15 (OR = 1.50, P = .01) were positively related to CRC screening. None of the delivery system factors were significant except the reminder system. Interview data provided in-depth information on how these factors help or hinder CRC screening. Discrepancies in findings were observed in chronic condition, colonoscopy performed by primary doctors, and the clinic-level system factors. CONCLUSIONS This study informs practitioners and policy makers on the effective multilevel strategies to promote CRC screening in primary Care Accountable Care Organization or equivalent settings. Some inconsistent findings between data sources require additional prospective cohort studies to validate those identified factors in question. The strategies may include (1) developing programs targeting relatively younger age groups or racial/ethnic minorities, (2) adapting multilevel/multicomponent interventions to address low demands and access of local population, (3) promoting annual physical examination as a cost-effective strategy, and (4) supporting Organizational capacity and infrastructure (eg, IT system) to facilitate implementation of evidence-based interventions.
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Clinic Exploration of Care Processes to Promote Colorectal Cancer Screening in Rural Accountable Care Organization Clinics: A Qualitative Case Study
NSUWorks, 2019Co-Authors: Bekmuratova Sarbinaz, Kim Jungyoon, Wang Hongmei, Young Lufei, Schober, Daniel J., Li Wu ChenAbstract:It is essential to have an effective Care process to promote colorectal cancer (CRC) screening particularly in rural areas. Primary Care health Care providers may have a significant impact on improving CRC screening rates among rural residents through systematic screening processes in their clinics. In this qualitative study, we aimed to explore the whole clinic processes of recommending and referring CRC screening in the rural Accountable Care Organization (ACO) primary Care clinics. We collected qualitative data through 21 semi-structured in-depth interviews with healthCare providers in rural primary Care ACO clinics in Nebraska. We audio recorded and transcribed the interviews and analyzed the data using an inductive content analysis approach. The qualitative analyses revealed that ACO clinics are promoting CRC screening through teamwork with enhanced utilization of electronic health records and various other reminder strategies for both providers and patients. Areas for improvement in ACO clinic processes were also identified
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barriers and facilitators of colorectal cancer screening for patients of rural Accountable Care Organization clinics a multilevel analysis
Journal of Rural Health, 2018Co-Authors: Hongmei Wang, Jungyoon Kim, Lufei Young, Fang Qiu, Abbey Gregg, Baojiang Chen, Neng Wan, Li Wu ChenAbstract:Purpose This study examines multilevel factors related to colorectal cancer (CRC) screening in a rural Accountable Care Organization (ACO) setting. Methods The study used electronic medical record data from 8 rural ACO clinics in Nebraska. The final sample included 15,866 average-risk patients aged 50-75 years who visited participating clinics at least once from June 2014 to May 2015. Logistic regression was conducted to examine simultaneous effects of patient, provider, and county characteristics on CRC screening after accounting for provider-county-level correlation using a generalized estimating equations method. Findings The results indicated that patients aged 65 years and older, non-Hispanic white, whose preferred language was English, who had insurance, who had a wellness visit in the past year, and who had chronic conditions were more likely to be up-to-date on CRC screening. Patients were also more likely to be up-to-date when their primary Care provider was a female medical doctor who was aware of clinic CRC screening protocols or who manually checked patient CRC screening status during the patient visit. Patients in a county with no gastroenterologist, a high poverty rate, and low insurance coverage were less likely to be up-to-date on CRC screening. Conclusions A variety of patient, provider, and county characteristics were associated with CRC screening. Effective strategies to promote CRC screening should address multilevel factors, including: targeting patients with identified individual barriers, modifying physician and clinical practices, and focusing on communities with low socioeconomic status or low levels of medical resources.
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examining factors influencing colorectal cancer screening of rural nebraskans using data from clinics participating in an Accountable Care Organization a study protocol
F1000Research, 2015Co-Authors: Lufei Young, Jungyoon Kim, Hongmei Wang, Li Wu ChenAbstract:Background: Although mortality rates of colorectal cancer (CRC) can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts. Understanding and eliminating barriers to cancer screening will decrease cancer burden and lead to substantial gains in quality and quantity of life for rural populations. However, existing studies have shown inconsistent findings and fail to address how contextual and provider-level factors impact CRC screening in addition to individual-level factors. Purpose: The purpose of the study is to examine multi-level factors related to CRC screening, and providers’ perception of barriers and facilitators of CRC screening in rural patients Cared for by Accountable Care Organization (ACO) clinics. Methods/Design: This is a convergent mixed method design. For the quantitative component, multiple data sources, such as electronic health records (EHRs), Area Resource File (ARF), and provider survey data, will be used to examine patient-, provider-, clinic-, and county-level factors. About 21,729 rural patients aged between 50 and 75 years who visited the participating ACO clinics in the past 12 months are included in the quantitative analysis. The qualitative methods include semi-structured in-depth interviews with healthCare professionals in selected rural clinics. Both quantitative and qualitative data will be merged for result interpretation. Quantitative data identifies “what” factors influence CRC screening, while qualitative data explores “how” these factors interact with CRC screening. The study setting is 10 ACO clinics located in nine rural Nebraska counties. Discussion: This will be the first study examining multi-level factors related to CRC screening in the new healthCare delivery system (i.e., ACO clinics) in rural communities. The study findings will enhance our understanding of how the ACO model, particularly in rural areas, interacts with provider- and patient-level factors influencing the CRC screening rate of rural patients.
