How Accountable Care Organizations Responded to Pediatric Incentives in the Alternative Quality Contract

Area of Science:

• Health Services Research
• Pediatric Health Policy
• Value-Based Care

Background:

• Accountable Care Organizations (ACOs) are increasingly adopting global payment arrangements.
• The Alternative Quality Contract (AQC) in Massachusetts incorporated pediatric quality measures and populations into global budgets.
• Adult-oriented ACOs faced challenges in adapting to pediatric-specific incentives.

Purpose of the Study:

• To characterize the pediatric infrastructure of adult-oriented ACOs participating in the AQC.
• To understand leaders' perspectives on ACOs' responses to pediatric quality and spending incentives.
• To evaluate the impact of the AQC on pediatric care quality and spending.

Main Methods:

• Data from Massachusetts Health Quality Partners and American Hospital Association Survey were used to assess pediatric infrastructure.
• Semi-structured interviews were conducted with 22 ACO leaders after 16-43 months of AQC experience.
• Pediatric infrastructure was categorized as extremely limited, basic, or substantial.

Main Results:

• ACOs' pediatric infrastructure varied significantly, from minimal to substantial.
• Most ACOs intensified pediatric quality improvement efforts and observed changes in quality metrics.
• ACOs investigated pediatric spending but struggled to alter utilization patterns; care for children with special needs was not incentivized.

Conclusions:

• Adult-oriented ACOs demonstrated increased pediatric quality improvement and spending reduction efforts under the AQC's pediatric incentives.
• The AQC's design did not adequately incentivize care for children with special health care needs.
• Future incentive programs should explicitly include pediatric populations, especially those with special health care needs.