负责任的护理组织在进入和共享储蓄奖金时的效率
Arnav Srivastava1, Addison Shay1, Samuel R Kaufman1
1Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor.
JAMA network open
|February 26, 2026
概括
在2017年政策变化之前和之后,效率较低的负责照顾组织 (ACO) 比有效的组织更有可能获得共享储蓄奖金. 这表明医疗保险共享储蓄计划可能不会始终奖励效率.
科学领域:
- 卫生政策 卫生政策
- 卫生经济学 卫生经济学
- 医疗保健管理的管理
背景情况:
- 医疗保险共享储蓄计划 (MSSP) 基准先前有利于历史支出,可能不利于高效的负责任的护理组织 (ACO).
- 随着基准计算的发展,包括2017年区域支出调整,旨在更好地奖励ACO效率.
- 这些基准分析政策变化对ACO跨效率级别的财务业绩的影响仍然不清楚.
研究的目的:
- 评估ACO的初始效率与其获得共享储蓄奖金的可能性之间的关联.
- 确定2017年区域基准调整如何影响该协会.
主要方法:
- 采用2013-2020年期间20%的医疗保险申请国家样本进行的横截面研究.
- ACOs根据其最初观察到的预期支出比率 (效率) 被分为四分之一.
- 多变量后勤回归分析了效率四分位数,共享储蓄奖金和2017年政策变化的影响之间的关系.
主要成果:
- 在402个ACO中,中位支出比率为1.000.
- 最有效的ACO在2017年调整后 (24.4%至45.2%) 获得奖金的可能性增加.
- 然而,效率最低的ACO在政策变化之前 (43.8%) 和之后 (60.7%) 获得奖金的几率始终显著提高,而这一差距没有缩小.
结论:
- 效率范围内的ACO在2017年区域调整后获得奖金的几率有所提高.
- 与更高效的ACO相比,效率较低的ACO始终表现出获得奖金的几率明显更高.
- 目前在MSSP中的基准分析政策可能无法充分激励或奖励更高水平的ACO效率.
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