Using a home time measure to differentiate ACO performance for seriously ill populations

Area of Science:

• Healthcare Policy and Management
• Geriatric Care
• Health Services Research

Background:

• Alternative Payment Models (APMs), including the ACO REACH model, are being piloted by the Centers for Medicare and Medicaid Services (CMS) to enhance care and quality of life for seriously ill populations (SIP).
• Days at Home (DAH) has been proposed as a metric to evaluate organizational performance within these APMs.
• Assessing the utility and feasibility of person-centered outcomes like DAH is crucial as CMS advances care models for seriously ill beneficiaries.

Purpose of the Study:

• To evaluate the feasibility of an Accountable Care Organization (ACO)-level Days at Home (DAH) measure.
• To examine characteristics associated with ACOs that achieve higher DAH for seriously ill beneficiaries.

Main Methods:

• Calculated DAH for Medicare fee-for-service beneficiaries aged 68+ attributed to a Medicare ACO (2014-2018) meeting seriously ill criteria.
• Aggregated and risk-adjusted DAH to the ACO level for seriously ill beneficiaries.
• Assessed associations between risk-adjusted DAH per person-year and ACO, beneficiary, and market characteristics.

Main Results:

• Seriously ill beneficiaries in ACOs averaged 349.3 risk-adjusted DAH per person-year, with notable variation (IQR: 4.21 days).
• ACOs with less racially diverse beneficiaries, those opting for two-sided risk models, and those in markets with fewer hospital/SNF beds reported more DAH.
• Organizational factors, including ACO size and risk level, were strongly linked to higher DAH.

Conclusions:

• Significant variation in DAH across ACOs indicates its potential to differentiate provider performance.
• Accurate risk adjustment is essential for the DAH metric's success, ensuring adequate resources for providers caring for seriously ill patients.
• ACOs with specific characteristics, such as larger size and higher risk engagement, are associated with improved Days at Home outcomes.