Pediatric Accountable Care Organizations: Insight From Early Adopters

Abstract

Partly in response to incentives in the Affordable Care Act, there has been major growth in accountable care organizations (ACO) in both the private and public sectors. For several reasons, growth of ACOs in pediatric care has been more modest than for older populations. The American Academy of Pediatrics collaborated with Leavitt Partners, LLC, to carry out a study of pediatric ACOs, including a series of 5 case studies of diverse pediatric models, a scan of Medicaid ACOs, and a summit of leaders in pediatric ACO development. These collaborative activities identified several issues in ACO formation and sustainability in pediatric settings and outlined a number of opportunities for the pediatric community in areas of organization, model change, and market dynamics; payment, financing, and contracting; quality and value; and use of new technologies. These insights can guide future work in pediatric ACO development.

General Pediatricians and Value-Based Payments

“…VBP programs began decades ago with pay-for-performance and bundled payment programs, and they have increasingly been used to adopt measures that promote evidencebased use of resources and avoidance of unnecessary cost. 1,2 Newer strategies, such as accountable care organizations (ACOs), aim to distribute shared savings across health care teams in part on the basis of a team's performance on a panel of strategically selected quality measures. Despite decades of experience, there is still little evidence on how best to design and implement these programs for many practice settings, particularly from the perspective of physicians.…”

The Financial Impact of Genetic Diseases in a Pediatric Accountable Care Organization

“…It is important to study and understand ACO payment models and how specific diseases or groups of patients affect payment distribution. Lowering medical spending is a primary goal of ACOs (1,2). To bend the cost curve of ACOs, previous studies investigated care coordination, utilization management, and pharmacy management (3)(4)(5).…”

Coordinated Care Organizations and mortality among low‐income infants in Oregon

“…Medicaid ACOs have been shown to improve access to care and care quality in some areas, for example, increasing in preventive care, decreasing in emergency department visits or inpatient days, and containing cost growth . Few studies have, however, investigated the impact of pediatric Medicaid ACO models on health care utilization, cost, and care quality partly because of modest growth of pediatric ACOs . Only one study to our knowledge examined the effect of Medicaid ACOs on childbirth outcomes and found no impact on infant inpatient mortality .…”

“…[18][19][20][21][22][23] Few studies have, however, investigated the impact of pediatric Medicaid ACO models on health care utilization, cost, and care quality [23][24][25] partly because of modest growth of pediatric ACOs. 26 Only one study to our knowledge examined the effect of Medicaid ACOs on childbirth outcomes and found no impact on infant inpatient mortality. 27 Specific for Oregon, a recent study investigated the impact of CCO implementation on neonatal and infant outcomes, including infant mortality.…”