- How ACO Organizational Characteristics Affect Preventive Care Quality: Lessons from ACOs’ First Year June 2016
Accountable Care Organizations (ACO) emerged as a novel payment model to create a coordinated health system whereby providers contract together to take collective responsibility for managing the cost and quality of care for a population of patients. Preventive care is critical to ACO success. Evaluating ACOs’ strategic choices in terms of their organizational structure and early performance provides an avenue to a better understanding of the factors behind preventive care quality. In a HCFO-funded study, Valerie Lewis, Ph.D., of Dartmouth College and colleagues conducted a cross-sectional study examining Medicare Shared Savings Program and Pioneer ACO Program participants and the association between preventive care quality performance and ACO characteristics to inform strategies for preventive care quality management.
This letter is a response to a critique of the researchers' publication, "Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending", published in the March 2016 Health Affairs.
- Appropriate baseline laboratory testing following ACEI or ARB initiation by Medicare FFS beneficiaries March 2016
Laboratory testing to identify contraindications and adverse drug reactions is important for safety of patients initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Rates and predictors of appropriate testing among Medicare fee-for-service beneficiaries are unknown. In this HCFO-funded study, the researchers examined baseline laboratory testing rates to identify predictors of suboptimal testing and to assess the prevalence of abnormal creatinine and potassium among beneficiaries initiating ACE inhibitors or ARBs.
Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously — via videoconference, telephone, or webchat — to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed. Drawing on HCFO-funded work, R. Adams Dudley, University of California, San Francisco, and colleagues assessed the variation in the quality of urgent health care among virtual visit companies.
Calls for transparency in health care prices are increasing, in an effort to encourage and enable patients to make value-based decisions. Yet there is very little evidence of whether and how patients use health care price transparency tools. In a HCFO-funded study, Anna Sinaiko, Harvard T.H. Chan School of Public Health, and colleagues evaluated the experiences of an insured population of nonelderly adults with Aetna’s Member Payment Estimator, a web-based tool that provides real-time, personalized, episode-level price estimates.
- Most Americans Do Not Believe That There Is An Association Between Health Care Prices And Quality Of Care April 2016
Many organizations are developing health care price information tools for consumers. However, consumers may avoid low-price care if they perceive price to be associated with quality. In a HCFO-funded study, Carolin Hagelskamp and David Schleifer of Public Agenda conducted a nationally representative survey to examine whether consumers perceive that price and quality are associated and whether the way in which questions are framed affects consumers’ responses.
Conventional wisdom among policymakers and health insurers is that retail clinics may reduce health care spending by substituting for more costly visits to physician offices or emergency departments. However, given their convenience and lower price, retail clinics may also lead to new utilization of health care services by patients who otherwise would not seek care, thus increasing spending. In his HCFO-funded study, Ateev Mehrotra, M.D., M.P.H., Harvard Medical School, and colleagues assessed whether retail clinic visits for low-acuity conditions represented substitution for more expensive care or new utilization of health care services, and whether the visits subsequently reduced health care spending.
Policymakers and health insurers generally view retail clinics as a delivery model that may reduce health care spending by substituting for more costly visits to physician offices or emergency departments (EDs). However, given their lower price and convenience, retail clinics may also lead to new utilization of health care services by patients who otherwise would not seek care, thus increasing spending. In a study funded by the Robert Wood Johnson Foundation Changes in Health Care Financing and Organization (HCFO) initiative, Ateev Mehrotra, M.D., M.P.H., Harvard Medical School, and colleagues assessed whether retail clinic visits for low-acuity conditions represented substitution for more expensive care or new utilization of health care services, and whether they subsequently reduced health care spending.
Nonprofit and for-profit hospitals respond differently to reductions in Medicare payments; thus, studies of the impact of legislated Medicare payment cuts on care of the uninsured should account for differences in hospital ownership in communities. In her HCFO-funded study, Jennifer Mellor, Ph.D., College of William and Mary, examined the amount of hospital outpatient care provided to the uninsured and its association with Medicare payment rate cuts following the implementation of Medicare's Outpatient Prospective Payment System.
- Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance January 2016
Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. In her HCFO-funded study, Valerie Lewis, Ph.D., and researchers created composite measures of preventive care quality to examine associations of ACO characteristics with performance.