Changes in patients' experiences in Medicare Accountable Care Organizations

J Michael McWilliams ¹, Bruce E Landon , Michael E Chernew

⁰From the Department of Health Care Policy, Harvard Medical School (J.M.M., B.E.L., M.E.C., A.M.Z.), the Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (J.M.M.), and the Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center (B.E.L.) - all in Boston.

The New England Journal of Medicine +

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October 30, 2014

View abstract on PubMed

Summary

Accountable Care Organizations (ACOs) improved timely access to care and physician communication for Medicare beneficiaries. Patient experience with overall care also improved for those with chronic conditions.

Area Of Science

Health Services Research
Healthcare Policy
Patient Experience

Background

Accountable Care Organizations (ACOs) aim to improve healthcare quality and efficiency.
ACO incentives may impact patient experiences with care, positively or negatively.

Purpose Of The Study

To evaluate the impact of Medicare ACO contracts on patient experiences with healthcare.
To compare patient experiences in ACO-attributed groups versus control groups.

Main Methods

Utilized Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data and Medicare claims.
Employed difference-in-differences analysis on 32,334 beneficiaries in ACOs and 251,593 in control groups.
Adjusted for patient sociodemographic and clinical characteristics.

Main Results

Differential improvements observed in timely access to care and primary physician awareness of specialty care post-ACO contracts (P=0.01, P=0.006).
No significant differential changes in physician ratings, interactions, or overall care initially.
Significant improvement in overall care ratings for patients with multiple chronic conditions and high predicted Medicare spending (P=0.02).

Conclusions

ACO contracts showed meaningful improvements in specific patient experience measures within the first year.
Performance remained unchanged in other patient experience areas during the initial year.

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