Patient Loyalty in a Mature <scp>IDS</scp> Market: Is Population Health Management Worth It?

Carlin, Caroline

doi:10.1111/1475-6773.12147

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Even the 4-year churn rates were lower than a previous study examining individual physicians, which found that 33% of beneficiaries changed physicians after 1 year. [3][4][5]7,8 One potential explanation for these lower churn rates is CMS prioritizing annual wellness visits (AWVs) in the CPC+ attribution methodology (see the Appendix for the CPC+ attribution methodology, Supplemental Digital Content 1, http:// links.lww.com/MLR/C853). In contrast, AWVs were not prioritized in the attribution methodology used in these previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Although a few studies have examined attribution stability for individual practitioners and ACOs, we are the first to assess attribution stability in advanced primary care models. [3][4][5][6][7][8] Because of differences between the attribution methods used in ACOs and advanced primary care models, examining advanced primary care models can help identify which methodological differences are important to attribution stability. We analyze the attribution methodology used in Medicare's largest primary care payment and delivery reform model: Comprehensive Primary Care Plus (CPC+).…”

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confidence: 99%

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Highly Stable Beneficiary Attribution in Medicare’s Comprehensive Primary Care Plus Model

He,

Hirsch,

Beadles

et al. 2024

Medical Care

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Background: Advanced primary care models are key in moving primary care practices toward greater accountability for the quality and cost of a beneficiary’s care. One critical but often overlooked detail in model design is the beneficiary attribution methodology. Attribution results are key inputs in calculating practice payments. Stable attribution yields predictable practice payments, fostering longer-term investments in advanced primary care. Objective: We examine attribution stability for Medicare fee-for-service beneficiaries in Medicare’s Comprehensive Primary Care Plus (CPC+) Model. Design: To measure attribution stability, we calculate churn rates, which we define as the percentage of beneficiaries eligible for CPC+ who were not attributed to the same practice in a later period. Using 2017–2021 CPC+ program data and Medicare administrative data, we calculate churn rates for CPC+ overall and for beneficiary subgroups. To assess whether CPC+ attribution was responsive enough to changes in a beneficiary’s practice, we calculate how long before attribution changes following a beneficiary’s long-distance move. Results: We find that for every 100 beneficiaries attributed to a CPC+ practice, 88 were still attributed to the same practice a year later (ie, churn rate of 12%), 79 were attributed 2 years later, 74 three years later, and 70 four years later. However, some vulnerable subgroups, such as disabled beneficiaries, had higher churn rates. Our analysis of long-distance movers reveals that only after 5 quarters did attribution change for more than half of these movers. Conclusions: Overall, high attribution stability may have encouraged CPC+ practices to make longer-term investments in advanced primary care.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Highly Stable Beneficiary Attribution in Medicare’s Comprehensive Primary Care Plus Model

He,

Hirsch,

Beadles

et al. 2024

Medical Care

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Narrow provider networks and willingness to pay for continuity of care and network breadth

Higuera

Carlin

Dowd

2018

Journal of Health Economics

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The Economics of Provider Payment Reform: Are Accountable Care Organizations the Answer?

Feldman¹

2015

Journal of Health Politics, Policy and Law

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A remarkable consensus has developed that the fee-for-service (FFS) approach for paying medical providers must be replaced. This payment approach is said to increase the volume of services without improving care coordination. In response to these calls, Medicare and private payers are experimenting with payment systems that combine the basic element of FFS - a fee for each service - with arrangements that allow providers to share the savings if they hold total spending per patient below a targeted amount. Medicare's accountable care organizations (ACOs) embody the shared savings approach to payment reform. Private payers have introduced total cost of care contracting (TCOC) in several locations. This article questions the consensus that FFS must go. If the fees are too high, then someone needs to "bite the bullet" and reduce fees in key areas. Hoping to control overspending by investment in ACOs is wishful thinking. I describe the theory and practice of shared savings payment systems and summarize recent TCOC contracting initiatives in the private sector. Medicare's shared savings approach is likely to be less effective than private contracts. Cutting providers' fees would be more efficient. Finally, the new payment models in the Affordable Care Act will not ease the problem of high prices for private payers.

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Patient Loyalty in a Mature IDS Market: Is Population Health Management Worth It?

Abstract: Population health management can be beneficial to the care system making this investment, particularly for patients exhibiting prior continuity in care system choice. The results suggest that co-located primary and specialty services are important in maintaining primary care loyalty.

Cited by 3 publications

References 9 publications

Highly Stable Beneficiary Attribution in Medicare’s Comprehensive Primary Care Plus Model

Highly Stable Beneficiary Attribution in Medicare’s Comprehensive Primary Care Plus Model

Narrow provider networks and willingness to pay for continuity of care and network breadth

The Economics of Provider Payment Reform: Are Accountable Care Organizations the Answer?

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