WEDNESDAY, Aug. 28 (HealthDay News) -- Early accountable care organization initiatives correlate with lower spending for elderly Medicare beneficiaries, but not necessarily with improved quality, according to a study published in the Aug. 28 issue of the Journal of the American Medical Association.
J. Michael McWilliams, M.D., Ph.D., from Harvard Medical School in Boston, and colleagues examined whether an early commercial accountable care organization initiative (Blue Cross Blue Shield of Massachusetts' Alternative Quality Contract [AQC]) was associated with reduced spending and improved quality for Medicare beneficiaries. Comparisons were made for elderly fee-for-service Medicare beneficiaries in Massachusetts served by 11 provider organizations entering the AQC versus beneficiaries served by other providers.
The researchers found that before entering the AQC the total quarterly spending per beneficiary was $150 higher for the intervention group than for the control group, and increased at a similar rate. The difference was reduced to $51 in year two of the intervention group's exposure to the AQC, constituting a significant 3.4 percent savings relative to the expected quarterly mean of $2,895. Savings in year one were not significant, but in year two they were mainly obtained from lower spending on outpatient care, especially for beneficiaries with five or more conditions. Improvements were seen in annual rates of low-density lipoprotein cholesterol testing for beneficiaries with diabetes and for those with cardiovascular disease. Performance on most quality measures did not change differentially.
"The AQC was associated with lower spending for Medicare beneficiaries but not with consistently improved quality," the authors write.
One author disclosed financial ties to the genomic and software industries.
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