问责护理组织领导人对医疗保险共享储蓄计划的看法:质量研究
Dhruv Khullar1,2, William L Schpero1,3, Lawrence P Casalino1
1Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
JAMA health forum
|March 15, 2024
概括
医疗保险共享储蓄计划 (MSSP) 领导者专注于健康访问和临床医生的参与. 策略有所不同,共享的储蓄分配给实践,但有些人面临着错误的激励措施.
科学领域:
- 卫生政策 卫生政策
- 以价值为基础的护理
- 负责的护理组织 负责的护理组织
背景情况:
- 医疗保险共享储蓄计划 (MSSP) 是一项大型,长期存在的美国基于价值的支付计划,拥有400多个负责任的护理组织 (ACO).
- 最近的改革和医疗保健系统的变化需要更清楚地了解ACO领导人在MSSP中的经验和观点.
研究的目的:
- 调查参与MSSP的ACO领导人遇到的战略优先事项,运营方法和挑战.
- 描述ACO领导层在应对计划变化和市场动态方面不断变化的格局.
主要方法:
- 一项定性研究,涉及49个不同的MSSP ACO (尺寸,结构和位置各异) 的领导人进行半结构面试.
- 在2022年9月29日至12月29日期间进行的采访中,探索了临床/护理管理努力,临床医生参与,储蓄分配,实践变化和成功因素.
- 分析的重点是确定与ACO倡议,绩效和临床医生动态相关的主要主题.
主要成果:
- 出现了五个主要主题:专注于年度健康访问,编码和护理过渡;使用基于关系和指标的临床医生参与;将至少一半的共享储蓄分配给实践;市场竞争影响招聘/保留;以及一些与医院相关的ACO的错误激励.
- 与医院相关的ACO占参与者的69%,中型/大型ACO (>10,000名受益者) 71%,农村ACO占35%.
- 参与的ACO在MSSP中的平均任期为8.1年.
结论:
- ACO领导人采用各种策略来协调临床医生,并强调每年健康访问,面临来自竞争护理模式的新压力.
- 调查结果强调,决策者需要在未来的MSSP改革和计划修改中考虑ACO领导人的观点.
- 了解这些不同的经验对于优化基于价值的护理计划至关重要.
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