Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic
The COVID pandemic disrupted health care spending and utilization, and the Medicare Shared Savings Program (MSSP), Medicare's largest value-based payment model with 11.2 million assigned beneficiaries, was no exception. Despite COVID, the 513 accountable care organizations (ACO) in MSSP returne...
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| Veröffentlicht in: | PloS one 2022-08, Vol.17 (8), p.e0272706 |
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| description | The COVID pandemic disrupted health care spending and utilization, and the Medicare Shared Savings Program (MSSP), Medicare's largest value-based payment model with 11.2 million assigned beneficiaries, was no exception. Despite COVID, the 513 accountable care organizations (ACO) in MSSP returned a program record $1.9 billion in net savings to Medicare in 2020. To understand the extent of COVID's impact on MSSP cost and quality, we describe how ACO spending changed in 2020 and further analyze changes in measured quality and utilization. We found that non-COVID per capita spending in MSSP fell by 8.3 percent from $11,496 to $10,537 (95% confidence interval(CI),-1,223.8 to-695.4, p |
| doi_str_mv | 10.1371/journal.pone.0272706 |
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Despite COVID, the 513 accountable care organizations (ACO) in MSSP returned a program record $1.9 billion in net savings to Medicare in 2020. To understand the extent of COVID's impact on MSSP cost and quality, we describe how ACO spending changed in 2020 and further analyze changes in measured quality and utilization. We found that non-COVID per capita spending in MSSP fell by 8.3 percent from $11,496 to $10,537 (95% confidence interval(CI),-1,223.8 to-695.4, p<0.001), driven by 14.6% and 7.5% reductions in per capita acute inpatient and outpatient spending, respectively. Utilization fell across inpatient, emergency, and outpatient settings. On quality metrics, preventive screening rates remained stable or improved, while control of diabetes and blood pressure worsened. Large reductions in non-COVID utilization helped ACOs succeed financially in 2020, but worsening chronic disease measures are concerning. The appropriateness of the benchmark methodology and exclusion of COVID-related spending, especially as the virus approaches endemicity, should be revisited to ensure bonus payments reflect advances in care delivery and health outcomes rather than COVID-related shifts in spending and utilization patterns.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0272706</identifier><identifier>PMID: 35960735</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accountable Care Organizations ; Aged ; Benchmarking ; Benchmarks ; Beneficiaries ; Bias ; Blood pressure ; Care and treatment ; Chronic illnesses ; Chronic obstructive pulmonary disease ; Coronaviruses ; Cost control ; Cost Savings - methods ; COVID-19 ; COVID-19 - epidemiology ; Diabetes mellitus ; Evaluation ; Government programs ; Health care ; Health care expenditures ; Health care policy ; Humans ; Long term health care ; Medical care ; Medical screening ; Medicare ; Medicine and Health Sciences ; Organizations ; Pandemics ; Patients ; Per capita ; Primary care ; Quality management ; Sensitivity analysis ; Social Sciences ; Subacute care ; Success ; Total quality ; United States - epidemiology ; Utilization ; Viruses</subject><ispartof>PloS one, 2022-08, Vol.17 (8), p.e0272706</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Yan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Yan et al 2022 Yan et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-e0834624f41fdf06601b17cd4769289e71868977c96bf32d7cd3a2164068b88e3</citedby><cites>FETCH-LOGICAL-c692t-e0834624f41fdf06601b17cd4769289e71868977c96bf32d7cd3a2164068b88e3</cites><orcidid>0000-0003-0286-5764</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9374212/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9374212/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35960735$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yan, Brandon W</creatorcontrib><creatorcontrib>Shashoua, Maya</creatorcontrib><creatorcontrib>Figueroa, Jose F</creatorcontrib><title>Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The COVID pandemic disrupted health care spending and utilization, and the Medicare Shared Savings Program (MSSP), Medicare's largest value-based payment model with 11.2 million assigned beneficiaries, was no exception. Despite COVID, the 513 accountable care organizations (ACO) in MSSP returned a program record $1.9 billion in net savings to Medicare in 2020. To understand the extent of COVID's impact on MSSP cost and quality, we describe how ACO spending changed in 2020 and further analyze changes in measured quality and utilization. We found that non-COVID per capita spending in MSSP fell by 8.3 percent from $11,496 to $10,537 (95% confidence interval(CI),-1,223.8 to-695.4, p<0.001), driven by 14.6% and 7.5% reductions in per capita acute inpatient and outpatient spending, respectively. Utilization fell across inpatient, emergency, and outpatient settings. On quality metrics, preventive screening rates remained stable or improved, while control of diabetes and blood pressure worsened. Large reductions in non-COVID utilization helped ACOs succeed financially in 2020, but worsening chronic disease measures are concerning. The appropriateness of the benchmark methodology and exclusion of COVID-related spending, especially as the virus approaches endemicity, should be revisited to ensure bonus payments reflect advances in care delivery and health outcomes rather than COVID-related shifts in spending and utilization patterns.</description><subject>Accountable Care Organizations</subject><subject>Aged</subject><subject>Benchmarking</subject><subject>Benchmarks</subject><subject>Beneficiaries</subject><subject>Bias</subject><subject>Blood pressure</subject><subject>Care and treatment</subject><subject>Chronic illnesses</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Coronaviruses</subject><subject>Cost control</subject><subject>Cost Savings - methods</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>Diabetes mellitus</subject><subject>Evaluation</subject><subject>Government programs</subject><subject>Health care</subject><subject>Health care expenditures</subject><subject>Health care policy</subject><subject>Humans</subject><subject>Long term health care</subject><subject>Medical care</subject><subject>Medical screening</subject><subject>Medicare</subject><subject>Medicine and Health Sciences</subject><subject>Organizations</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Per capita</subject><subject>Primary care</subject><subject>Quality management</subject><subject>Sensitivity analysis</subject><subject>Social Sciences</subject><subject>Subacute care</subject><subject>Success</subject><subject>Total quality</subject><subject>United States - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yan, Brandon W</au><au>Shashoua, Maya</au><au>Figueroa, Jose F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-08-12</date><risdate>2022</risdate><volume>17</volume><issue>8</issue><spage>e0272706</spage><pages>e0272706-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The COVID pandemic disrupted health care spending and utilization, and the Medicare Shared Savings Program (MSSP), Medicare's largest value-based payment model with 11.2 million assigned beneficiaries, was no exception. Despite COVID, the 513 accountable care organizations (ACO) in MSSP returned a program record $1.9 billion in net savings to Medicare in 2020. To understand the extent of COVID's impact on MSSP cost and quality, we describe how ACO spending changed in 2020 and further analyze changes in measured quality and utilization. We found that non-COVID per capita spending in MSSP fell by 8.3 percent from $11,496 to $10,537 (95% confidence interval(CI),-1,223.8 to-695.4, p<0.001), driven by 14.6% and 7.5% reductions in per capita acute inpatient and outpatient spending, respectively. Utilization fell across inpatient, emergency, and outpatient settings. On quality metrics, preventive screening rates remained stable or improved, while control of diabetes and blood pressure worsened. Large reductions in non-COVID utilization helped ACOs succeed financially in 2020, but worsening chronic disease measures are concerning. The appropriateness of the benchmark methodology and exclusion of COVID-related spending, especially as the virus approaches endemicity, should be revisited to ensure bonus payments reflect advances in care delivery and health outcomes rather than COVID-related shifts in spending and utilization patterns.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>35960735</pmid><doi>10.1371/journal.pone.0272706</doi><tpages>e0272706</tpages><orcidid>https://orcid.org/0000-0003-0286-5764</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Accountable Care Organizations Aged Benchmarking Benchmarks Beneficiaries Bias Blood pressure Care and treatment Chronic illnesses Chronic obstructive pulmonary disease Coronaviruses Cost control Cost Savings - methods COVID-19 COVID-19 - epidemiology Diabetes mellitus Evaluation Government programs Health care Health care expenditures Health care policy Humans Long term health care Medical care Medical screening Medicare Medicine and Health Sciences Organizations Pandemics Patients Per capita Primary care Quality management Sensitivity analysis Social Sciences Subacute care Success Total quality United States - epidemiology Utilization Viruses |
| title | Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic |
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