基准变化如何影响参与负责任的护理组织:自愿支付模式的前景
Alice J Chen1, J Michael McWilliams2
1University of Southern California, Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics.
在医疗保险共享储蓄计划 (MSSP) 中,负责任的护理组织 (ACOs) 在他们的基准降低时更有可能退出. 这突显了基准在ACO参与和支付模式设计中的关键作用.
科学领域:
- 健康经济学
- 医疗保健政策
- 医学经济学
背景情况:
- 自愿的替代支付模式需要提供者的参与才能成功.
- 医疗保险共享储蓄计划 (MSSP) 旨在改革提供者支付.
- 负责任的护理组织 (ACOs) 是这些模式的关键参与者.
研究的目的:
- 分析基准变化对ACO参与MSSP的影响.
- 了解基准调整和ACO退学率之间的因果关系.
主要方法:
- 使用了一项自然实验,该实验源于2017年影响ACO支出基准的规则变化.
- 分析了基准变化对ACO参与决策的差异性影响.
- 基准值降低对ACO退出可能性的影响量化.
主要成果:
- 经历有效基准下降的ACO更有可能退出7个百分点.
- 更大的基准降低显著增加了11个百分点的学率.
- 已超过基准支出的ACO对基准削减的敏感度更高.
结论:
- 基准价值对ACO参与MSSP有很大的影响.
- 支付模式设计必须考虑基准变化对参与的影响.
- 需要有效的长期激励来鼓励持续的ACO参与和支出削减.
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