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Michael J Mcwilliams – One of the best experts on this subject based on the ideXlab platform.

  • early effects of an Accountable Care Organization model for underserved areas
    The New England Journal of Medicine, 2019
    Co-Authors: Matthew J Trombley, Betty Fout, Sasha Brodsky, Michael J Mcwilliams, David J Nyweide, Brant Morefield

    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 …

  • association of changes in medication use and adherence with Accountable Care Organization exposure in patients with cardiovascular disease or diabetes
    JAMA Cardiology, 2017
    Co-Authors: Michael J Mcwilliams, Mehdi Najafzadeh, William H Shrank, Jennifer M Polinski

    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.

  • variation in Accountable Care Organization spending and sensitivity to risk adjustment implications for benchmarking
    Health Affairs, 2016
    Co-Authors: Sherri Rose, Alan M Zaslavsky, Michael J Mcwilliams

    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…

Genevieve M Hale – One of the best experts on this subject based on the ideXlab platform.

Vahakn B. Shahinian – One of the best experts on this subject based on the ideXlab platform.

  • Accountable Care Organizations and Spending for Patients Undergoing Long-Term Dialysis.
    Clinical journal of the American Society of Nephrology : CJASN, 2020
    Co-Authors: Shivani Bakre, John M. Hollingsworth, Phyllis Yan, Emily J. Lawton, Richard A. Hirth, Vahakn B. Shahinian

    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.

  • Accountable Care Organizations and Prostate Cancer Care
    Urology practice, 2016
    Co-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. Shahinian

    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.

  • randomized controlled trial of centralized vaccine reminder recall to improve adult vaccination rates in an Accountable Care Organization setting
    Preventive medicine reports, 2019
    Co-Authors: Laura P Hurley, Brenda L Beaty, Steven Lockhart, Dennis Gurfinkel, Miriam L Dickinson, Heather Roth, Allison Kempe

    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.

  • 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, 2019
    Co-Authors: Jungyoon Kim, Hongmei Wang, Lufei Young, Tzeyu L Michaud, Mohammad Siahpush, Paraskevi A Farazi, Li Wu Chen

    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.

  • Clinic Exploration of Care Processes to Promote Colorectal Cancer Screening in Rural Accountable Care Organization Clinics: A Qualitative Case Study
    NSUWorks, 2019
    Co-Authors: Bekmuratova Sarbinaz, Kim Jungyoon, Wang Hongmei, Young Lufei, Schober, Daniel J., Li Wu Chen

    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

  • barriers and facilitators of colorectal cancer screening for patients of rural Accountable Care Organization clinics a multilevel analysis
    Journal of Rural Health, 2018
    Co-Authors: Hongmei Wang, Jungyoon Kim, Lufei Young, Fang Qiu, Abbey Gregg, Baojiang Chen, Neng Wan, Li Wu Chen

    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 medimedical 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.