ACO Reduced Costs and Maintained Quality In Pediatric Medicaid Population

Dr. Eric W. Christensen, PhD Health Economist Children’s Hospitals and Clinics of Minnesota Minneapolis, MN

Dr. Eric Christensen

MedicalResearch.com Interview with:
Dr. Eric W. Christensen, PhD
Health Economist
Children’s Hospitals and Clinics of Minnesota
Minneapolis, MN

Medical Research: What is the background for this study?

Dr. Christensen: National healthcare expenditures are up from 5.0% of gross domestic product in 1960 to 17.4% in 2013. We must find ways to control cost while maintaining quality. Accountable care organizations (ACOs) were designed to control a population’s health care cost while maintaining or improving quality. This study was an examination of one ACO exclusively covering a pediatric Medicaid population.

Medical Research: What are the main findings?

Dr. Christensen: We found that health care utilization and cost patterns were associated with the length of time patients were attributed to this ACO, where attribution length can be thought of as a proxy for consistent primary care from ACO providers. Specifically, attribution length of 2 or more years was associated with a 40.6% decrease in inpatient days. This decrease was partially offset by increases in outpatient visits (as one would expect with a primary care focus), emergency department visits, and use of pharmaceuticals. Combined these utilization changes resulted in a cost reduction 15.7% for those attributed 2 or more years. These changes were achieved while meeting quality benchmarks.

Medical Research: What should clinicians and patients take away from your report?

Dr. Christensen: ACOs have the potential to reduce cost while maintaining quality at least among a pediatric Medicaid population. Longer attribution—consistent primary care—matters.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Christensen: Researchers should continue to examine the effectiveness of ACOs and similar models on quality and cost. While the pediatric Medicaid population is not representative of all children, it includes many of the most vulnerable. Our study was not able to look at the impact of social determinants of health on the effectiveness of the ACO. Doing this is essential as estimates are that 85% of what impacts health falls outside of health care.

Citation:

 Christensen EW, Payne NR. Effect of Attribution Length on the Use and Cost of Health Care for a Pediatric Medicaid Accountable Care Organization. JAMA Pediatr. Published online December 14, 2015. doi:10.1001/jamapediatrics.2015.3446.

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Dr. Eric W. Christensen, PhD (2015). ACO Reduced Costs and Maintained Quality In Pediatric Medicaid Population