Comparing the Effects of Payment Reform in Medicare ACOs, Commercial ACOs, and Medicare Advantage

Drawing upon information obtained from Medicare claims, commercial claims, and Banner’s electronic medical record, among other data sets, Joseph Newhouse and his team will undertake multiple comparisons of the performance of Banner’s Medicare ACO, its commercial ACO, its Medicare Advantage plan, and traditional Medicare with respect to beneficiary care. The researchers will analyze the following indicators: risk selection of both patients and providers; quality indicators; total spending; and utilization, including emergency room visits, overall hospital admissions, and ambulatory care–sensitive admissions. In addition, the team will examine the different risk-sharing arrangements for physicians within Banner and the potential consequences of this variation. Federal policymakers and health system leaders will gain valuable evidence about the effect that different risk arrangements have on a health care organization’s ability to deliver high-value care to a defined patient population.