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. 2018 Jul 1;24(7):e207-e215.

Forgotten patients: ACO attribution omits those with low service use and the dying

Mariétou H Ouayogodé  1 , Ellen Meara, Chiang-Hua Chang, Stephanie R Raymond, Julie P W Bynum, Valerie A Lewis, Carrie H Colla
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Forgotten patients: ACO attribution omits those with low service use and the dying

Mariétou H Ouayogodé et al. Am J Manag Care. .

Abstract

Objectives: Alternative payment models, such as accountable care organizations, hold provider groups accountable for an assigned patient population, but little is known about unassigned patients. We compared clinical and utilization profiles of patients attributable to a provider group with those of patients not attributable to any provider group.

Study design: Cross-sectional study of 2012 Medicare fee-for-service beneficiaries 21 years and older.

Methods: We applied the Medicare Shared Savings Program attribution approach to assign beneficiaries to 2 mutually exclusive categories: attributable or unattributable. We compared attributable and unattributable beneficiaries according to demographics, dual eligibility for Medicaid, nursing home residency, clinical comorbidities, annual service utilization, annual spending, and 1- and 2-year mortality. We estimated multivariate regression models describing correlates of attribution status.

Results: Most beneficiaries (88%) were attributable to a provider group. The remaining 12% were unattributable. Beneficiaries unattributable to any provider group were more likely to be younger, male, and from a minority group; to have disability as the basis for enrollment; and to live in high-poverty areas. Unattributable beneficiaries included 3 distinct subgroups: nonusers of care, decedents, and those with healthcare service use but no qualifying evaluation and management visits. Many unattributable Medicare beneficiaries had minimal use of healthcare services, with the exception of a small subgroup of beneficiaries who died within the attribution year.

Conclusions: Attribution approaches that more fully capture unattributable patients with low service use and patients near the end of life should be considered to reward population health efforts and improve end-of-life care.

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Figures

Figure 1
Figure 1
Attribution Status of Fee-for-Service Medicare Beneficiaries in 2012 (21 years or older)
Figure 2
Figure 2
Proportion of Medicare Beneficiaries Un-attributable to Provider Groups in 2012 by Hospital Referral Region (HRR)
See this image and copyright information in PMC

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References

    1. Bard M, Nugent M. Accountable Care Organizations: Your Guide to Design, Strategy, and Implementation. Health Administration Press; 2011.
    1. Muhlestein D, Saunders R, McClellan M. Growth Of ACOs And Alternative Payment Models In 2017. Health Affairs Blog. 2017;2017
    1. NAACOS Joins CMS in Welcoming 525 ACOs in 2017! [press release] 2017.
    1. McWilliams JM, Chernew ME, Landon BE, Schwartz AL. Performance differences in year 1 of pioneer accountable care organizations. New England Journal of Medicine. 2015;372(20):1927–1936. - PMC - PubMed
    1. Pyenson BS, Fitch KV, Iwasaki K, Berrios MM. The Two Medicare ACO Programs: Medicare Shared Savings and Pioneer—Risk/Actuarial Differences. Milliman Inc; New York, NY: 2011.

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