Association Between Care Management and Outcomes Among Patients With Complex Needs in Medicare Accountable Care Organizations

Ouayogodé, Mariétou H.; Mainor, Alexander J; Meara, Ellen; Bynum, Julie; Colla, Carrie H.

doi:10.1001/jamanetworkopen.2019.6939

Cited by 34 publications

(27 citation statements)

References 25 publications

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“…1,11 Interventions to improve outcomes and reduce costs have, to date, had limited demonstrable impact in this patient population. [12][13][14][15][16][17] This may be due to ineffective interventions, an inability to detect effective elements of interventions due to heterogeneity of treatment effects, measuring outcomes that do not reflect patients' goals of care, 18,19 or insufficient understanding of unmet care needs that reflect patient priorities.…”

Section: Introductionmentioning

confidence: 99%

Aligning care with the personal values of patients with complex care needs

Tuzzio

Berry

Gleason

et al. 2021

Health Services Research

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Objective To identify opportunities to align care with the personal values of patients from three distinct groups with complex medical, behavioral, and social needs. Data Sources/Study Setting Between June and August 2019, we conducted semi‐structured interviews with individuals with complex care needs in two integrated health care delivery systems. Study Design Qualitative study using semi‐structured interviews. Data Collection Methods We interviewed three groups of patients at Kaiser Permanente Washington and Kaiser Permanente Colorado representing three distinct profiles of complex care needs: Group A (“obesity, opioid prescription, and low‐resourced neighborhood”), Group B (“older, high medical morbidity, emergency department, and hospital use”), and Group C (“older, mental and physical health concerns, and low‐resourced neighborhood”). These profiles were identified based on prior work and prioritized by internal primary care stakeholders. Interview transcripts were analyzed using thematic analysis. Principal Findings Twenty‐four patients participated; eight from each complex needs profile. Mean age across groups was 71 (range 48–86) years. We identified five themes common across the three groups that captured patients' views regarding values‐aligned care. These themes focused on the importance of care teams exploring and acknowledging a patient's values, providing access to nonphysician providers who have different perspectives on care delivery, offering values‐aligned mental health care, ensuring connection to community‐based resources that support values and address needs, and providing care that supports the patient plus their family and caregivers. Conclusions Our results suggest several opportunities to improve how care is delivered to patients with different complex medical, behavioral, and social needs. Future research is needed to better understand how to incorporate these opportunities into health care.

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Section: Introductionmentioning

confidence: 99%

Aligning care with the personal values of patients with complex care needs

Tuzzio

Berry

Gleason

et al. 2021

Health Services Research

View full text Add to dashboard Cite

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“…The use of patient care navigators further contributed to identified cost reductions in the outpatient clinic literature. Such positions have been developed to assist patients (often virtually) during the global pandemic and beyond for both clinical and non-clinical initiatives [ 15 , 25 ]. Similar clinic-associated tasks conducted by employees and/or providers were identified as participating in such actions but not specifically identified as patient navigators [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Pandemic Pause: Systematic Review of Cost Variables for Ambulatory Care Organizations Participating in Accountable Care Organizations

2021

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Ambulatory health care provider organizations participating in Accountable Care Organizations (ACOs) organizations assume costs beyond typical practice operations that are directly associated with value-based care initiatives. Identifying these variables that influence such costs are essential to an organization’s financial viability. To enable the U.S. healthcare system to respond to the COVID-19 pandemic CMS issued blanket waivers that permit enhanced flexibility, extension, and other emergency declaration changes to ACO reporting requirements through the unforeseen future. This relaxation and even pausing of reporting requirements encouraged the researchers to conduct a systematic review and identify variables that have influenced costs incurred by ambulatory care organizations participating in ACOs prior to the emergency declaration. The research findings identified ACO-ambulatory care variables (enhanced patient care management, health information technology improvements, and organizational ownership/reimbursement models) that helped to reduce costs to the ambulatory care organization. Additional variables (social determinants of health/environmental conditions, lack of integration/standardization, and misalignment of financial incentives) were also identified in the literature as having influenced costs for ambulatory care organizations while participating in an ACO initiative with CMS. Findings can assist ambulatory care organizations to focus on new and optimized strategies as they begin to prepare for the post-pandemic resumption of ACO quality reporting requirements once the emergency declaration is eventually lifted.

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“…But a 2019 Dartmouth College study of 244 Medicare Shared Savings Program ACOs did not find that their care management and coordination efforts improved health outcomes or lowered costs. 10 "Many of these programs have disappointed in terms of savings, and the effects are smaller than expected," says coauthor Carrie Colla, a health economist at the Dartmouth Institute for Health Policy and Clinical Practice. One challenge is that ACOs don't dominate the US health care landscape.…”

Section: 'Cohesion'mentioning

confidence: 99%