Nav: Home

Study finds ACOs need a balance of PCPs and specialists to best reduce health care costs

July 10, 2019

Accountable care organizations (ACOs), the health care delivery model created by the Affordable Care Act in an effort to reduce Medicare costs while improving coordination and quality of care, typically rely on primary care providers (PCPs) to steer the boat.

"The central message has been that the providers within the ACO need to focus on delivering care through primary care providers," says Vishal Shetty, a University of Massachusetts Amherst Ph.D. student in the School of Public Health and Health Sciences.

But an ACO's ability to reduce spending may require a specific balance of involvement from medical specialists, such as a cardiologist, orthopedist or neurologist. That is the central finding of a UMass Amherst study by health service researchers in JAMA Network Open, a monthly open "access medical journal published by the American Medical Association. Health service researchers evaluate health policy and create evidence to inform health policymakers in their efforts to provide value and equity and improve outcomes for patients and society.

Shetty and three assistant professors - David Chin, Laura Balzer and Kimberley Geissler - examined data on 620 ACOs from the Centers for Medicare and Medicaid Services' Shared Savings Program to investigate the association between office visits to medical specialists and health care spending. The data covered more than five years, from April 2012 through September 2017.

ACOs in which 40 to 45 percent of the patient visits were provided by a specialist had $1,129 lower annual spending per beneficiary than ACOs with a specialist visit proportion of less than 35 percent, and $752 lower annual spending per beneficiary than ACOs with a specialist visit proportion of 60 percent or more.

"This study provides an empirical backing to the idea that a balance between primary care providers and specialists in the delivery of care for ACO patients, especially high-risk patients with chronic conditions, appears to provide optimal cost savings, or lower expenditures, for these organizations," Shetty says. "We speculated that would be the case, but I don't think we anticipated $1,000 lower spending per patient in the more balanced ACOs."

The ACO model shifts the financial responsibility to health care providers by establishing incentives for value-based care over volume. The idea is that better coordination of care will simultaneously reduce unnecessary medical services, improve health outcomes and lower costs. Under the Medicare Shared Savings Program, ACOs receive a bonus if their spending comes in below a benchmark.

The researchers also found that as the proportion of specialist visits increased in an ACO, the number of emergency department (ED) visits, hospital discharges and skilled nursing facility discharges (SNF) decreased.

"The finding of high expenditures among ACOs with the lowest specialist encounter proportion suggests patients in this group receive outpatient care (predominantly delivered by PCPs) associated with higher ED, hospital and SNF encounter rates," the study states.

Adds Shetty, "We speculated that patients seen only or primarily by primary care providers may receive suboptimal care, especially if they are chronic-care, high-risk patients."

To more consistently curb health care costs, the study suggests policymakers may want to consider adding medical specialists to ACO governance and creating better financial incentives for specialists in the ACO model.

"There aren't strong incentives as it stands now for specialists to join ACOs," Shetty says. "Fee-for-service reimbursement is still a higher incentive."

University of Massachusetts at Amherst

Related Public Health Articles:

Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
Public health experts support federally mandated smoke-free public housing
In response to a new federal rule mandating smoke-free policies in federally funded public housing authorities, three public health experts applaud the efforts of the US Department of Housing and Urban Development to protect nonsmoking residents from the harmful effects of tobacco exposure.
The Lancet Public Health: UK soft drinks industry levy estimated to have significant health benefits, especially among children
The UK soft drinks industry levy, due to be introduced in April 2018, is estimated to have significant health benefits, especially among children, according to the first study to estimate its health impact, published in The Lancet Public Health.
More Public Health News and Public Health Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Teaching For Better Humans
More than test scores or good grades — what do kids need to prepare them for the future? This hour, guest host Manoush Zomorodi and TED speakers explore how to help children grow into better humans, in and out of the classroom. Guests include educators Olympia Della Flora and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...