Out-of-network primary care linked to rising ACO costs, study finds

Out-of-network primary care linked to rising ACO costs, study finds

Accountable Care Organizations -- or ACOs -- formed for the first time in 2011, designed to combat rising medical costs and provide more coordinated care to Medicare patients. But the savings have been inconsistent nationwide. A new Portland State University study looked at what's driving those inconsistencies and what ACOs might do to resolve the issue. The study was published in the February issue of Health Affairs by OHSU-PSU School of Public Health Assistant Professor Sunny Lin. "Primary care has the potential to unlock the key to reducing healthcare costs," Lin said. Decreasing the percent of primary care delivered out-of-network across all Medicare ACOs by just one-tenth of a percentage point could save the Medicare system $45 million a year, the study found. ACOs are self-organized providers working together to better control healthcare costs. The organizations have federal approval and receive Medicare funding, but in lieu of the traditional fee-for-service model, ACOs are incentivized to spend less per patient. If they succeed in saving money through coordinated care, they share the remaining government funding. However, ACOs have no control over who their patients see, including whether their patients seek care outside of the ACO network. "What the study found is that it actually didn't matter how much specialty care was received by non-ACO providers," said Lin, who co-authored the study with John Hollingsworth of the University of Michigan Medical School. "What mattered more was how well their primary care providers were aligned in the ACO." Those findings go against common wisdom that dictated when it comes to spending, specialty care costs more to the system. The study found that "leakage" -- the percent of care patients receive outside their network -- impacted healthcare spending more for primary care providers than specialty care providers. In marginalized communities or ACOs with a higher proportion of patients of color, leakage was even higher. Lin said this was likely because those populations have a harder time maintaining continuity of care and experience more barriers to seeing the same primary care provider repeatedly. ACOs need to be cognizant of these barriers and try to find ways to reduce them in order to save money -- and more importantly better serve their patients". Sunny Lin, Assistant Professor, OHSU-PSU School of Public Health Related Stories



Also in Industry News

How to decide whether or not to start treatment for prostate cancer?
How to decide whether or not to start treatment for prostate cancer?

0 Comments

How to decide whether or not to start treatment for prostate cancer?

Read More

Analysis of the SARS-CoV-2 proteome via visual tools
Analysis of the SARS-CoV-2 proteome via visual tools

0 Comments

Analysis of the SARS-CoV-2 proteome via visual tools

Read More

$65m investment increases British Patient Capital’s exposure to life sciences and health technology
$65m investment increases British Patient Capital’s exposure to life sciences and health technology

0 Comments

$65m investment increases British Patient Capital’s exposure to life sciences and health technology

Read More