This article is more than 5 years old. Information may no longer be current.
Pediatric ACO reduces inpatient resource use, hospital costs
Click Here to Manage Email Alerts
Development of a pediatric accountable care organization within a pediatric hospital helped to reduce the use of inpatient resources and hospital spending, especially among Medicaid-covered children with multiple chronic conditions, according to recent research in JAMA Pediatrics.
“Little is known about the effect of pediatric accountable care organizations (ACOs) on the use and costs of health care resources, especially in a Medicaid population,” Eric W. Christensen, PhD, and Nathaniel R. Payne, MD, of the department of research and sponsored programs at Children’s Hospitals and Clinics of Minnesota, wrote. “In 2013, Children’s Hospitals and Clinics of Minnesota (CHC) contracted with the State of Minnesota Department of Human Services to develop a pediatric Medicaid accountable care organization. The assumption for effectiveness was that patients who chose to receive their primary care at a CHC facility would have better coordination and consistency of care, resulting in decreased use of high-cost inpatient or outpatient services. This study examined that assumption.”
The researchers retrospectively analyzed the Medicaid insurance claims of 28,794 children treated at a single children’s hospital from September 2013 to May 2015. They determined the relationship between the length of primary care in an ACO and the use and cost of medical services.
Study results showed that attribution of an ACO to a primary care practice resulted in a 40.6% (95% CI, 19.4%-61.8%) decrease in inpatient days over a 2-year period. However, attribution also resulted in a 23.3% (95% CI, 20.4%-26.3%) increase in office visits, 5.8% (95% CI, 1.4%-10.2%) increase in ED visits and 15.3% (95% CI, 12.5%-18%) increase in pharmaceutical use.
The researchers also found that the decreased use of health care resources associated with the ACO resulted in a 15.7% (95% CI, 6.6%-24.8%) hospital cost reduction.
“Our findings suggest significant and durable inpatient health care resource use and cost reductions associated with longer attribution to the ACO, where attribution is a proxy for exposure to consistent primary care within the ACO,” Christensen and Payne wrote.
In an accompanying editorial, Magrielle H. Eisen, MLSP, MSS, and David M. Rubin, MD, MSCE, of the policy lab at The Children’s Hospital of Philadelphia’s Research Institute, endorsed Christensen and colleagues for their groundbreaking findings, stating that their research has elevated the understanding of how pediatric accountable care organizations impact patients and health care resources. Eisen and Rubin also highlighted questions raised by this study.
“These observations raise two critical questions for hospitals and health systems involved in pediatric Medicaid accountable care organizations,” Eisen and Rubin wrote. “First, what level of responsibility should we assume in sustaining patient engagement in the primary care medical home? Second, what types of efforts to maintain accountable care organization attribution would yield a solid return on investment in a shared risk and shared savings environment?” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts