Accountability across the Continuum: The Participation of Postacute Care Providers in Accountable Care Organizations

Abstract

Objective: To examine the extent to which accountable care organizations (ACOs) formally incorporate postacute care providers.

Data sources: The National Survey of ACOs (N = 269, response rate 66 percent).

Study design: We report statistics on ACOs' formal inclusion of postacute care providers and the organizational characteristics and clinical capabilities of ACOs that have postacute care.

Principal findings: Half of ACOs formally include at least one postacute service, with inclusion at higher rates in ACOs with commercial (64 percent) and Medicaid contracts (70 percent) compared to ACOs with Medicare contracts only (45 percent). ACOs that have a formal relationship with a postacute provider are more likely to have advanced transition management, end of life planning, readmission prevention, and care management capabilities.

Conclusions: Many ACOs have not formally engaged postacute care, which may leave room to improve service integration and care management.

Keywords: Accountable care organizations; health care reform; postacute care.

Figure 1

Proportion of Accountable Care Organizations (ACOs) with Advanced Capabilities Relevant to Older Populations, by PAC Inclusion Notes: PAC is postacute care and includes rehabilitation, home health, and skilled nursing services. *p < .05, **p < .01, ***p < .001. Significance tests use two‐sample t‐tests comparing ACOs that include postacute care within the ACO versus ACOs that contract outside or do not have a relationship with these services. “Advanced capabilities” indicates self‐scoring of 7–9 on a 1–9 scale based on behavioral anchoring to guide the responses.

Figure 2

Accountable Care Organization (ACO) Outcomes, by Postacute Care Inclusion Notes: Acute care readmissions is mean acute care readmissions (all‐cause 30 day) per 1,000 discharges in the performance period. Inpatient rehabilitation facility (IRF) discharges is mean IRF discharges per 1,000 person years in the performance period. Skilled nursing facility (SNF) discharges is mean SNF discharges per 1,000 person years in the performance period. *p < .05, **p < .01, ***p < .001. Significance tests compare ACOs that include postacute care within the ACO versus ACOs that do not have a relationship with these services.