影响负责任护理组织决定继续或退出医疗保险共享储蓄计划的因素
Meiling Ying1, Jane H Forman2, Sitara Murali3
1Department of Foundations of Medicine, New York University Langone Health, New York, NY 11501, United States.
Health affairs scholar
|February 5, 2024
概括
医疗保险共享储蓄计划 (MSSP) 的成功之路计划导致更多的负责任护理组织 (ACO) 退出而不是进入. 这一转变促使ACO重新评估财务风险和收益,影响了参与基于价值的护理模式.
科学领域:
- 卫生政策 卫生政策
- 医疗保健管理的管理
- 卫生经济学 卫生经济学
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) 提高护理质量并降低传统医疗保险的成本.
- 根据"通往成功之路"计划 (2019年启动) 强制转向双边金融风险模型改变了ACO参与动态.
- 不到20%的MSSP参与者最初采用了双面风险,促使计划变化.
研究的目的:
- 在实施"成功之路"计划后,调查负责护理组织 (ACO) 参与决策背后的原因.
- 了解金融风险模型和基准分析的变化如何影响ACO与医疗保险共享储蓄计划 (MSSP) 的参与.
主要方法:
- 对负责照顾组织 (ACO) 领导人进行了定性采访.
- 分析重点是ACO对财务风险,潜在储蓄,非收入利益和参与替代计划的重新评估.
主要成果:
- "成功之路"计划促使ACO重新评估潜在的共享储蓄与损失,特别是由于基准测试的变化.
- ACO领导人重新考虑了非收入福利,并将MSSP参与与其他基于价值的护理计划进行了比较.
- 该计划导致更多的ACO第一次退出,而不是进入MSSP.
结论:
- 政策制定者应实施战略,鼓励更多的ACO在MSSP内的下行风险模型中注册.
- 提高招生风险承担模式对于实现共享储蓄和提供负责任的护理至关重要.
- 战略应侧重于使ACO能够成功管理财务风险,同时提高护理质量.
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