Understanding the Management of High-Need, High-Cost Patients Within Accountable Care Organizations

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The Commonwealth Fund and the five-foundation collaborative in which it participates share the following goal: by 2020, 30 percent of health care organizations participating in value-based payment models will have adopted proven, evidence-based interventions for high-need, high-cost patients that improve patient outcomes and lower the overall costs of care. Accountable care organizations (ACOs) are a primary target of this goal. With Fund support, Dartmouth researchers have conducted three waves of the National Survey of ACOs (the fourth is currently in process) to examine factors influencing the formation, implementation, and performance of ACOs and to provide information on ACO characteristics, capabilities, and strategies. This grant will support the tracking of progress toward the goal set by the Fund and the collaborative. Through analysis of the 2017 National Survey of Accountable Care Organizations, the Dartmouth team will learn about the programs that ACOs have put in place to serve high-need, high-cost patients. Based on these findings, the researchers will then identify up to 20 ACOs that have implemented promising systems and processes, such as protocols to segment high-need patients or integrated physical and behavioral health care services for complex patients. Interviews with leaders at these ACOs will explore accomplishments and implementation challenges that could inform the efforts of other ACOs. Finally, the team will use the ACO survey findings, patient encounter data from Medicare claims, and information about physician practice information from the Healthcare Organization Services dataset to examine relationships between ACO characteristics and high-need, high-cost patient outcomes. This work will yield much-needed baseline estimates of ACOs' adoption of evidence-based strategies, enabling The Commonwealth Fund and five-foundation collaborative to monitor progress toward their stated goal for health system participation in value-based payment models. This project will inform ACO health system leaders, policymakers, and the members of the five-foundation collaborative about adoption of strategies and capabilities associated with improved management of high-need, high-cost patients. Findings will also inform stakeholders about whether those strategies are associated with better patient outcomes and lower overall costs.

Grant Details

Grantee Organization:
Trustees of Dartmouth College
Principal Investigator:
Ellen Meara, Ph.D., and Carrie Colla, Ph.D.
Award Amount:
$300,000.00
Approval Date:
July 11, 2017

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