Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care...

Area of Science:

• Health Services Research
• Cardiology
• Health Policy

Background:

• Accountable Care Organizations (ACOs) aim to enhance healthcare quality and reduce costs for patients with heart failure (HF).
• Significant variation exists in HF admission rates across ACOs, with associated factors not fully understood.
• Understanding these variations is crucial for optimizing HF care within ACO models.

Purpose of the Study:

• To analyze the variation in risk-standardized acute admission rates for heart failure patients across Medicare Shared Savings Program ACOs.
• To identify specific ACO characteristics associated with higher or lower performance in managing HF admissions.

Main Methods:

• Utilized Medicare fee-for-service data for heart failure patients assigned to Medicare Shared Savings Program ACOs in 2017.
• Calculated risk-standardized acute admission rates and categorized ACO performance into three tiers.
• Examined associations between ACO attributes (e.g., size, affiliation, location, provider mix) and performance categories.

Main Results:

• A total of 283,795 heart failure patients across 467 ACOs were analyzed.
• Median risk-standardized acute admission rate was 87 per 100 beneficiaries, with a wide range (61-109).
• ACOs with better performance often had fewer Black beneficiaries and lacked hospital affiliation; worse-performing ACOs were larger, Northeast-based, hospital-affiliated, and had fewer PCPs.

Conclusions:

• Acute admissions are frequent among heart failure patients within ACOs, demonstrating considerable performance variation.
• Specific structural and demographic characteristics of ACOs are linked to their performance in managing HF admissions.
• Further research is needed to clarify the interplay between ACO characteristics and heart failure admission risk.