ACO Participation Associated With Increased Care for Clinically Vulnerable Patients

A research team sought to understand the association between patient characteristics of a physician group and the group’s participation in a newly formed accountable care organization (ACO). According to a new study, the team found that physicians participating in ACOs cared for more clinically vulnerable patients. The findings were published online in JAMA Network Open.

“Accountable care organizations are an important and far-reaching recent change to health care with exponential growth over the past few years, covering more than 32 million lives by 2016,” the research team led by Rachel Werner, MD, PhD, from the Center for Health Equity Research and Promotion and Crescenz VA Medical Center, and colleagues wrote.

According to the research team, often times a physicians’ groups decision to participate in an ACO depends on the providers’ capabilities to incorporate management tools to help manage and coordinate care for patients with complex needs. Past research has shown that ACOs were predominantly formed in geographic areas with a higher proportion of well-insured patients, and additional research showed that despite geographic differences, ACOs were less likely to include physicians working in areas that were more populated by low-income, low-educated, racial minority patients. Because research to date has not examined whether the characteristics of physicians’ patients are associated with which physician groups participate in ACOs, Dr Werner and colleagues estimated the association between physicians’ patient characteristics and their likelihood of participating in a newly formed ACO.

For their study, the researchers conducted a retrospective cohort study that investigated a 20% random sample of Medicare fee-for-service beneficiaries attributed to physician groups. They were identified in Medicare claims before ACO participation from January 1, 2010, through December 31, 2011. Further, the researchers identified physician groups that participated and did not participate in the Medicare Shared Savings Program (MSSP) from January 1, 2012, through December 31, 2014, and data analyses were conducted from September 1, 2017, to March 20, 2018.

“Our overall approach was to estimate the likelihood of a physician group participating in an ACO in 2014 based on the characteristics of that physician group’s patients before ACO formation, focusing on measures of the vulnerability of the group’s patients,” Dr Werner and colleagues explained. “All ACO-participating physician groups were compared with ACO-nonparticipating physician groups for reference.”

According to the findings, among 67,891 physician groups caring for 5,394,181 patients, 7215 physician groups participated in an MSSP ACO by 2014. When the researchers compared the average percentages across practices with physicians’ who were participating in an ACO, they found that those in an ACO had a greater proportion of black patients (12.1% vs 10.6%), dually enrolled patients (20.8% vs 17.7%), and clinically high-risk patients (34.2% vs 30.2%). Further, the physician groups in an ACO had fewer specialists and had more physicians who were affiliated with a health system but fewer who were hospital based.  

“Accountable care organizations may be an effective approach to target care among high-risk patients,” Dr Werner and colleagues concluded. “In this study, physician groups that participated in the MSSP ACO program cared for more clinically vulnerable patients than did nonparticipating groups, and ACO-participating physician groups cared for an equally large number of socially vulnerable patients compared with nonparticipating physician groups.”

—Julie Gould

Reference:

Werner RM, Kanter GP, Polsky D. Association of Physician Group Participation in Accountable Care Organizations With Patient Social and Clinical Characteristics [published online January 18, 2019]. JAMA Netw Open. 2019;2(1):e187220. doi:10.1001/jamanetworkopen.2018.7220.

For more articles by IH Executive, click here

For similar articles by First Report Managed Care, click here