1932
0
  1. Home
  2. A-Z Publications
  3. Annual Review of Public Health
  4. Volume 41, 2020
  5. Article

Annual Review of Public Health

Volume 41, 2020

The Impact of Medicare's Alternative Payment Models on the Value of Care

Abstract

Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this goal has been to implement alternative payment models (APMs) that encourage high-value care by holding providers financially accountable for both the quality and the costs of care. In particular, the CMS has implemented and scaled up two types of APMs: population-based models that emphasize accountability for overall quality and costs for defined patient populations, and episode-based payment models that emphasize accountability for quality and costs for discrete care. Both APM types have been associated with modest reductions in Medicare spending without apparent compromises in quality. However, concerns about the unintended consequences of these APMs remain, and more work is needed in several important areas. Nonetheless, both APM types represent steps to build on along the path toward a higher-value national health care system.

Keyword(s): accountable care organizations, bundled payments, Medicare, payment reform, value-based payment
Loading

Article metrics loading...

/content/journals/10.1146/annurev-publhealth-040119-094327
2020-04-01
2024-04-16
Loading full text...

Full text loading...

/deliver/fulltext/publhealth/41/1/annurev-publhealth-040119-094327.html?itemId=/content/journals/10.1146/annurev-publhealth-040119-094327&mimeType=html&fmt=ahah

Literature Cited

  1. 1. 
    Anderson RE, Ayanian JZ, Zaslavsky AM, McWilliams JM 2014. Quality of care and racial disparities in Medicare among potential ACOs. J. Gen. Intern. Med. 29:1296–304
     [Google Scholar]
  2. 2. 
    Barnett ML, Wilcock A, McWilliams JM, Epstein AM, Joynt Maddox KE et al. 2019. Two-year evaluation of mandatory bundled payments for joint replacement. N. Engl. J. Med. 380:252–62
     [Google Scholar]
  3. 3. 
    Busch AB, Huskamp HA, McWilliams JM 2016. Early efforts by Medicare accountable care organizations have limited effect on mental illness care and management. Health Aff 35:1247–56
     [Google Scholar]
  4. 4. 
    Calsyn M, Emanuel EJ. 2014. Controlling costs by expanding the Medicare acute care episode demonstration. JAMA Intern. Med. 174:1438–39
     [Google Scholar]
  5. 5. 
    Chen LM, Ryan AM, Shih T, Thumma JR, Dimick JB 2018. Medicare's Acute Care Episode demonstration: effects of bundled payments on costs and quality of surgical care. Health Serv. Res. 53:632–48
     [Google Scholar]
  6. 6. 
    CMS (Cent. Medicare Medicaid Serv.) 2017. Medicare Acute Care Episode (ACE) demonstration. CMS.gov. https://innovation.cms.gov/initiatives/ACE
    [Google Scholar]
  7. 7. 
    CMS (Cent. Medicare Medicaid Serv.) 2018. ACO investment model. CMS.gov. https://innovation.cms.gov/initiatives/ACO-Investment-Model/
    [Google Scholar]
  8. 8. 
    CMS (Cent. Medicare Medicaid Serv.) 2018. MACRA. CMS.gov. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/macra-mips-and-apms/macra-mips-and-apms.html
    [Google Scholar]
  9. 9. 
    CMS (Cent. Medicare Medicaid Serv.) 2018. Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration. CMS.gov. https://innovation.cms.gov/Files/x/maqi-faqs.pdf
    [Google Scholar]
  10. 10. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Accountable care organizations (ACOs). CMS.gov https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
    [Google Scholar]
  11. 11. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Accountable Health Communities model. CMS.gov https://innovation.cms.gov/initiatives/ahcm/
    [Google Scholar]
  12. 12. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. All-payer advanced alternative payment models (APMs) option. Quality Payment Program https://qpp.cms.gov/apms/all-payer-advanced-apms
    [Google Scholar]
  13. 13. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. BPCI Advanced. CMS.gov. https://innovation.cms.gov/initiatives/bpci-advanced
    [Google Scholar]
  14. 14. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Bundled Payments for Care Improvement (BPCI) initiative: general information. CMS.gov. https://innovation.cms.gov/initiatives/bundled-payments/
    [Google Scholar]
  15. 15. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Comprehensive Care for Joint Replacement model. CMS.gov. https://innovation.cms.gov/initiatives/CJR
    [Google Scholar]
  16. 16. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Comprehensive Primary Care initiative. CMS.gov. https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/
    [Google Scholar]
  17. 17. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Comprehensive Primary Care Plus. CMS.gov. https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/
    [Google Scholar]
  18. 18. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Direct provider contracting models—request for information. CMS.gov. https://innovation.cms.gov/initiatives/direct-provider-contracting/
    [Google Scholar]
  19. 19. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Home Health Value-Based Purchasing model. CMS.gov. https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model
    [Google Scholar]
  20. 20. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Next Generation ACO model. CMS.gov. https://innovation.cms.gov/initiatives/next-generation-aco-model/
    [Google Scholar]
  21. 21. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Patient Driven Payment model. Updated May 16. https://www.cms.gov/medicare/medicare-fee-for-service-payment/snfpps/pdpm.html
  22. 22. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Pioneer ACO model. CMS.gov. https://innovation.cms.gov/initiatives/pioneer-aco-model/
    [Google Scholar]
  23. 23. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Quality Payment Program. CMS.gov. https://www.cms.gov/medicare/quality-payment-program/quality-payment-program.html
    [Google Scholar]
  24. 24. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. Shared Savings Program. CMS.gov. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html
    [Google Scholar]
  25. 25. 
    CMS (Cent. Medicare Medicaid Serv.) 2019. The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program. CMS.gov. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/SNF-VBP-Page.html
    [Google Scholar]
  26. 26. 
    Dale SB, Ghosh A, Peikes DN, Day TJ, Yoon FB et al. 2016. Two-year costs and quality in the Comprehensive Primary Care Initiative. N. Engl. J. Med. 374:2345–56
     [Google Scholar]
  27. 27. 
    Dummit L, Marrufo G, Marshall J, Ackerman T, Bergman S et al. 2018. CMS Bundled Payments for Care Improvement Initiative Models 2–4: year 5 evaluation & monitoring annual report Fin. Rep., Lewin Group Falls Church, VA: https://downloads.cms.gov/files/cmmi/bpci-models2-4-yr5evalrpt.pdf
    [Google Scholar]
  28. 28. 
    Dummit LA, Kahvecioglu D, Marrufo G, Rajkumar R, Marshall J et al. 2016. Association between hospital participation in a Medicare Bundled Payment Initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA 316:1267–78
     [Google Scholar]
  29. 29. 
    Epstein AM, Jha AK, Orav EJ, Liebman DL, Audet AMJ et al. 2014. Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics. Health Aff 33:95–102
     [Google Scholar]
  30. 30. 
    Finkelstein A, Ji Y, Mahoney N, Skinner J 2018. Mandatory Medicare bundled payment program for lower extremity joint replacement and discharge to institutional postacute care: interim analysis of the first year of a 5-year randomized trial. JAMA 320:892–900
     [Google Scholar]
  31. 31. 
    Fout B, Trombley M, Brodsky S, Marek B, Bengtsson A et al. 2018. Evaluation of the accountable care organization investment model: AIM impacts in the first performance year Rep., Abt Assoc Rockville, MD: https://innovation.cms.gov/Files/reports/aim-firstannrpt.pdf
  32. 32. 
    Gold J. 2013. 9 Pioneer ACOs jump ship after first year. Kaiser Health News July 16. https://khn.org/news/9-pioneer-acos-jump-ship-after-first-year/
    [Google Scholar]
  33. 33. 
    Green L. 2016. Evaluation of CMMI accountable care organization initiatives: Pioneer ACO final report Rep., L&M Policy Res Washington, DC: https://innovation.cms.gov/Files/reports/pioneeraco-finalevalrpt.pdf
  34. 34. 
    Hsu J, Price M, Spirt J, Vogeli C, Brand R et al. 2016. Patient population loss at a large Pioneer accountable care organization and implications for refining the program. Health Aff 35:422–30
     [Google Scholar]
  35. 35. 
    Hsu J, Price M, Vogeli C, Brand R, Chernew ME et al. 2017. Bending the spending curve by altering care delivery patterns: the role of care management within a Pioneer ACO. Health Aff 36:876–84
     [Google Scholar]
  36. 36. 
    Ibrahim SA, Kim H, McConnell KJ 2016. The CMS comprehensive care model and racial disparity in joint replacement. JAMA 316:1258–59
     [Google Scholar]
  37. 37. 
    Joynt Maddox KE, Orav JE, Zheng J, Epstein AM 2018. Evaluation of Medicare's bundled payments initiative for medical conditions. N. Engl. J. Med. 379:260–269
     [Google Scholar]
  38. 38. 
    Lewis VA, Colla CH, Carluzzo KL, Kler SE, Fisher ES 2013. Accountable care organizations in the United States: market and demographic factors associated with formation. Health Serv. Res. 48:1840–58
     [Google Scholar]
  39. 39. 
    Lewis VA, Larson BK, McClurg AB, Boswell RG, Fisher ES 2012. The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles. Health Aff 31:1777–85
     [Google Scholar]
  40. 40. 
    Liao JM, Pauly MV, Navathe AS 2020. When should Medicare mandate participation in alternative payment models?. Health Aff In press
    [Google Scholar]
  41. 41. 
    Lowell KH. 2018. First annual report: Next Generation Accountable Care Organization (NGACO) model evaluation Rep., NORC, Univ Chicago, Bethesda, MD: https://innovation.cms.gov/Files/reports/nextgenaco-firstannrpt.pdf
  42. 42. 
    Markovitz AA, Hollingsworth JM, Ayanian JZ, Norton EC, Moloci NM et al. 2019. Risk adjustment in Medicare ACO program deters coding increases but may lead ACOs to drop high-risk beneficiaries. Health Aff 38:253–61
     [Google Scholar]
  43. 43. 
    McWilliams JM, Chernew ME, Landon BE, Schwartz AL 2015. Performance differences in year 1 of Pioneer accountable care organizations. N. Engl. J. Med. 372:1927–36
     [Google Scholar]
  44. 44. 
    McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL 2016. Early performance of accountable care organizations in Medicare. N. Engl. J. Med. 374:2357–66
     [Google Scholar]
  45. 45. 
    McWilliams JM, Hatfield LA, Landon BE, Hamed P, Chernew ME 2018. Medicare spending after 3 years of the Medicare Shared Savings Program. N. Engl. J. Med. 379:1139–49
     [Google Scholar]
  46. 46. 
    Nathan H, Thumma JR, Ryan AM, Dimick JB 2019. Early impact of Medicare accountable care organizations on inpatient surgical spending. Ann. Surg. 269:191–96
     [Google Scholar]
  47. 47. 
    Navathe AS, Emanuel EJ, Liao JM 2018. Pitfalls and potential in Medicare's move toward outpatient care episodes. Ann. Intern. Med. 169:802–3
     [Google Scholar]
  48. 48. 
    Navathe AS, Liao JM, Dykstra SE, Wang E, Lyon ZM et al. 2018. Association of hospital participation in a Medicare bundled payment program with volume and case mix of lower extremity joint replacement episodes. JAMA 320:901–10
     [Google Scholar]
  49. 49. 
    Peikes D, Dale S, Ghosh A, Taylor EF, Swankoski K et al. 2018. The Comprehensive Primary Care Initiative: effects on spending, quality, patients, and physicians. Health Aff 37:890–99
     [Google Scholar]
  50. 50. 
    Pollack CE, Armstrong K. 2011. Accountable care organizations and health care disparities. JAMA 305:1706–7
     [Google Scholar]
  51. 51. 
    Schwartz AL, Chernew ME, Landon BE, McWilliams JM 2015. Changes in low-value services in year 1 of the Medicare Pioneer accountable care organization program. JAMA Intern. Med. 175:1815–25
     [Google Scholar]
  52. 52. 
    Urdapilleta O, Weinberg D, Pedersen S, Kim G, Cannon-Jones S, Woodward J 2013. Evaluation of the Medicare Acute Care Episode (ACE) demonstration: final evaluation report Rep., IMPAQ Int Columbia, MD: https://downloads.cms.gov/files/cmmi/ACE-EvaluationReport-Final-5-2-14.pdf
  53. 53. 
    Werner RW, Kanter GP, Polsky D 2019. Association of physician group participation in accountable care organizations with patient social and clinical characteristics. JAMA Netw. Open. 2:e1872220
     [Google Scholar]
  54. 54. 
    Yasaitis LC, Pajerowski W, Polsky D, Werner RM 2016. Physicians’ participation in ACOs is lower in places with vulnerable populations than in more affluent communities. Health Aff 35:1382–90
     [Google Scholar]
/content/journals/10.1146/annurev-publhealth-040119-094327
Loading
  • Article Type: Review Article

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error