Quality of Care Improves for Patients with Diabetes in Medicare Shared Savings Accountable Care Organizations: Organizational Characteristics Associated with Performance

Abstract

Accountable care organizations (ACOs), a primary care-centric delivery and payment model, aim to promote integrated population health, which may improve care for those with chronic conditions such as diabetes. Research has shown that, overall, the ACO model is effective at reducing costs, but there is substantial variation in how effective different types of ACOs are at impacting costs and improving care delivery. This study examines how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes. Secondary data were analyzed retrospectively to examine Medicare Shared Savings Program (MSSP) ACOs' performance on diabetes metrics in the first 2 years of ACO contracts. Ordinary least squares was used to analyze 162 MSSP ACOs with publicly available performance data and the National Survey of ACOs. ACOs improved performance significantly for patients with diabetes between contract years 1 and 2. In year 1, also having a private payer contract and an increased number of services within the ACO were positively associated with performance, while having a community health center or a hospital were negatively associated with performance. Better performance in year 1 was negatively associated with improved performance in year 2. This study found that ACOs substantively improved diabetes management within initial contract years. ACOs may need different types of support throughout their contracts to ensure continued improvements in performance.

Keywords: chronic disease; diabetes; pay for performance; quality measurement.

FIG. 1.

Average accountable care organization performance on diabetes measures for performance years 1 and 2. Each bar represents one of the diabetes quality measures. Light gray indicates performance in year 1 and dark gray shows the increase in performance during year 2. t Tests were used to test significance between unadjusted year 1 and year 2 performance scores for each diabetes measure. Significance testing was restricted to those ACOs with both survey data and Centers for Medicare & Medicaid Services performance data for consistency across analyses and because it was the more conservative approach. *P < .05; ***P < .001. ACO, accountable care organization; LDL, low-density lipoprotein cholesterol.