在有Medicare ACOs的组织中,所有付款人基于价值的合同签订
1Heller School for Social Policy and Management, Brandeis University, 415 South St, MS035, Waltham, MA 02454.
The American journal of managed care
|November 10, 2023
概括
医疗保险共享储蓄计划 (MSSP) 的组织越来越多地使用与其他付款人的基于价值的合同. 医疗保险ACO合同中大多数有保险的生命都涉及下行风险,比商业或医疗保险优势计划更为如此.
科学领域:
- 卫生政策 卫生政策
- 医疗保健管理的管理
- 以价值为基础的护理
背景情况:
- 医疗保险共享储蓄计划 (MSSP) 鼓励负责任的护理组织 (ACO) 采用基于价值的护理模式.
- 为了评估更广泛的医疗保健转型,了解MSSP参与者之间非Medicare价值基础合同的程度至关重要.
研究的目的:
- 测量MSSP参与者中非Medicare价值基础合同的流行程度.
- 为了确定参与这些组织中具有下行金融风险的合同的程度.
主要方法:
- 对2022年对参与MSSP的100个组织进行的调查进行横截面分析.
- 分析各种基于价值的合同类型 (医疗保险ACO,医疗保险优势,商业,医疗补助) 和风险安排中的覆盖寿命分布.
- 合同流行率和风险结构与2018年数据的比较.
主要成果:
- 据MSSP参与者报道,有1550万人的生命被基于价值的合同所覆盖.
- 大约75%的受访者与商业和医疗保险优势计划签订了基于价值的合同.
- 医疗保险ACO合同中70%的被保险生命包括下行风险,而商业计划中为51%和医疗保险优势计划中为45%.
- 自2018年以来,基于价值的医疗保险优势合同中受访者比例翻了一番,商业合同增加了一半.
结论:
- 在传统的医疗保险之外,MSSP参与者已经显著扩大了他们对基于价值的合同的参与.
- 与商业或医疗保险优势合同相比,Medicare ACO合同显示,与下行风险相关的保险人数比例较高.
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