ACOs with risk-bearing experience are likely taking steps to reduce low-value medical services

Abstract

Objectives

Accountable Care Organizations (ACOs) are groups of healthcare providers responsible for quality of care and spending for a defined patient population. The elimination of low-value medical services will improve quality and reduce costs, and therefore, ACOs should actively work to reduce the use of low-value services. We set out to identify ACO characteristics associated with implementation of strategies to reduce overuse.

Study Design

Survey analysis

Methods

We used the National Survey of ACOs to determine the percentage of responding ACOs aware of Choosing Wisely and to what degree ACOs have taken steps to reduce the use of low-value services. We identified characteristics of ACOs associated with implementing low-value care reducing strategies using three statistical models (Stepwise and Lasso logistic regression, Random Forest).

Results

Responding executives of 155 out of 267 ACOs (58%) were aware of Choosing Wisely. 84 ACO leaders said that their ACOs also actively implemented strategies to reduce the use of low-value services, largely through educating physicians and stimulating shared decision making. All three models identified the presence of at least one commercial payer contract and prior, joint experience pursuing risk-based payment contracts as the most important predictors of an ACO actively implementing strategies to reduce low-value care.

Conclusions

In the first year of implementation, only one third of ACOs had taken steps to reduce the use of low-value medical services. Safety-net ACOs and those with little experience as a risk-bearing organization need more time and support from healthcare payers and the Choosing Wisely campaign to prioritize the reduction of overuse.

Précis

Experience with risk-based contracting best predicts active engagement of ACOs in reducing low-value medical services, mainly through physician education and encouraging shared decision making.