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      How Do Accountable Care Organizations Deliver Preventive Care Services? A Mixed-Methods Study

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          Abstract

          Background

          The Affordable Care Act and the introduction of accountable care organizations (ACOs) have increased the incentives for patients and providers to engage in preventive care, for example, through quality metrics linked to disease prevention. However, little is known about how ACOs deliver preventive care services.

          Objective

          To understand how Medicare ACOs provide preventive care services to their attributed patients.

          Design

          Mixed-methods study using survey data reporting Medicare ACO capabilities in patient care management and interviews with high-performing ACOs.

          Participants

          ACO executives completed survey data on 283 Medicare ACOs. These data were supplemented with 39 interviews conducted across 18 Medicare ACOs with executive-level leaders and associated clinical and managerial staff.

          Main Measures

          Survey measures included ACO performance, organizational characteristics, collaboration experience, and capabilities in care management and quality improvement. Telephone interviews followed a semi-structured interview guide and explored the mechanisms used, and motivations of, ACOs to deliver preventive care services.

          Key Results

          Medicare ACOs that reported being comprehensively engaged in the planning and management of patient care - including conducting reminders for preventive care services - had more beneficiaries and had a history of collaboration experience, but were not more likely to receive shared savings or achieve high-quality scores compared to other surveyed ACOs. Interviews revealed that offering annual wellness visits and having a system-wide approach to closing preventive care gaps are key mechanisms used by high-performing ACOs to address patients’ preventive care needs. Few programs or initiatives were identified that specifically target clinically complex patients. Aside from meeting patient needs, motivations for ACOs included increasing patient attribution and meeting performance targets.

          Conclusions

          ACOs are increasingly motivated to deliver preventive care services. Understanding the mechanisms and motivations used by high-performing ACOs may help both providers and payers to increase the use of preventive care.

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          Most cited references13

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          Greater use of preventive services in U.S. health care could save lives at little or no cost.

          There is broad debate over whether preventive health services save money or represent a good investment. This paper analyzes the estimated cost of adopting a package of twenty proven preventive services--including tobacco cessation screening, alcohol abuse screening, and daily aspirin use--against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million life-years annually. What's more, increasing the use of these services from current levels to 90 percent in 2006 would result in total savings of $3.7 billion, or 0.2 percent of U.S. personal health care spending. These findings suggest that policy makers should pursue options that move the nation toward greater use of proven preventive services.
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            Few Americans Receive All High-Priority, Appropriate Clinical Preventive Services

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              First national survey of ACOs finds that physicians are playing strong leadership and ownership roles.

              The extent to which physicians lead, own, and govern accountable care organizations (ACOs) is unknown. However, physicians' involvement in ACOs will influence how clinicians and patients perceive the ACO model, how effective these organizations are at improving quality and costs, and how future ACOs will be organized. From October 2012 to May 2013 we fielded the National Survey of Accountable Care Organizations, the first such survey of public and private ACOs. We found that 51 percent of ACOs were physician-led, with another 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. The broad reach of physician leadership has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians.
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                Author and article information

                Contributors
                +44 (0)1865 743660 , adam.briggs@dph.ox.ac.uk
                Journal
                J Gen Intern Med
                J Gen Intern Med
                Journal of General Internal Medicine
                Springer US (New York )
                0884-8734
                1525-1497
                20 August 2019
                20 August 2019
                November 2019
                : 34
                : 11
                : 2451-2459
                Affiliations
                [1 ]GRID grid.254880.3, ISNI 0000 0001 2179 2404, The Dartmouth Institute for Health Policy and Clinical Practice, , Dartmouth College, ; Lebanon, NH USA
                [2 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, The Nuffield Department of Population Health, , University of Oxford, ; Old Road Campus, Headington, Oxford, OX3 7LF UK
                [3 ]GRID grid.208078.5, ISNI 0000000419370394, University of Connecticut School of Medicine, ; Farmington, CT USA
                [4 ]GRID grid.47840.3f, ISNI 0000 0001 2181 7878, School of Public Health, , University of California, ; Berkeley, CA USA
                Article
                5271
                10.1007/s11606-019-05271-5
                6848496
                31432439
                268ae258-353e-43af-ab4b-d8776e13fcde
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 25 September 2018
                : 29 March 2019
                : 15 May 2019
                Categories
                Original Research
                Custom metadata
                © Society of General Internal Medicine 2019

                Internal medicine
                prevention,accountable care organizations,medicare,preventive care,health care reform

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