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Spending outcomes among patients with cancer in accountable care organizations 4 years after implementation
Parsa Erfani1, Jessica Phelan2, E John Orav3,4
1Harvard Medical School, Boston, Massachusetts.
Background:
The long-term impact of affordable care organizations (ACOs) on cancer spending remains unknown. The authors examined whether practices that became ACOs altered their spending for patients with cancer in the first 4 years after ACO implementation.
Methods:
By using national Medicare data from 2011 to 2017, a random sample of 20% of fee-for-service Medicare beneficiaries aged 65 years and older with cancer was obtained (n = 866,532), and each patient was assigned to a practice. Practices that became ACOs in the Medicare Shared Savings Program were matched to non-ACO practices. Total, cancer-specific, and service category-specific yearly spending per patient was calculated. A difference-in-differences model was used to determine spending changes associated with ACO status for patients with cancer in the 4 years after ACO implementation.
Results:
The introduction of ACOs did not have a significant impact on overall spending for patients with cancer in the 2 years after ACO implementation (difference, -$38; 95% CI, -$268, $191; P = .74). Changes in spending also did not differ between ACO and non-ACO patients within service categories or among the 11 cancer types examined. The lack of difference in spending for patients with cancer in ACO and non-ACO practices persisted in the third and fourth years after ACO implementation (difference, -$120; 95% CI, -$284, $525; P = .56).
Conclusions:
ACOs did not significantly change spending for patients with cancer in the first 4 years after their implementation compared with non-ACOs. This prompts a reevaluation of the current efficacy of ACOs in reducing spending for cancer care and may encourage policymakers to reconsider the incentive structures of ACOs.
Lay Summary:
Accountable care organizations (ACOs) were developed to curtail health care spending and improve quality, but their effects on cancer spending in their first 2 years have been minimal. The long-term impact of ACOs on cancer spending remains unknown. By using data from 866,532 Medicare beneficiaries with cancer, the authors observed that the association of a practice with an ACO did not significantly change total yearly spending per patient in the first 4 years after ACO implementation. This finding prompts a reevaluation of the current efficacy of ACOs in reducing spending for cancer care.
Insights
Affordable Care Organizations (ACOs) did not significantly alter cancer care spending in their first four years. This study suggests a need to re-evaluate ACOs' effectiveness in reducing costs for cancer patients.
Area of Science:
- Health economics
- Oncology
- Healthcare policy
Background:
- Affordable Care Organizations (ACOs) aim to reduce healthcare spending and improve quality.
- The long-term impact of ACOs on cancer care spending is not well understood.
Purpose of the Study:
- To examine the impact of ACOs on spending for patients with cancer.
- To determine if ACO participation altered healthcare spending in the four years following implementation.
Main Methods:
- Analysis of national Medicare data (2011-2017) for beneficiaries aged 65+ with cancer.
- Matched ACO practices with non-ACO practices.
- Used a difference-in-differences model to assess spending changes.
Main Results:
- ACOs did not significantly impact overall cancer spending in the first two years (-$38; P = .74).
- No significant spending differences were observed across service categories or cancer types.
- This lack of impact persisted through the fourth year post-implementation (-$120; P = .56).
Conclusions:
- ACOs did not significantly change cancer care spending in the initial four years.
- Findings suggest a need to re-evaluate ACO efficacy in reducing cancer care costs.
- Policymakers may need to reconsider ACO incentive structures.
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