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Member Research and Reports

Member Research and Reports

UMass: Team Finds ACOs Need a Balance of Primary Care and Specialist Providers to Optimize Reductions in Health Care Spending

Accountable care organizations (ACOs) typically rely on primary care providers to steer the boat. But an ACO’s ability to reduce spending may require a specific balance of involvement from medical specialists, such as a cardiologist, orthopedist or neurologist. That is the central finding of a University of Massachusetts-Amherst School of Public Health and Health Sciences study by health policy researchers in JAMA Network Open.

Health policy and management doctoral student Mr. Vishal Shetty and three assistant professors – Drs. David Chin, Laura Balzer and Kimberley Geissler – examined data on 620 ACOs from the Centers for Medicare and Medicaid Services’ Shared Savings Program to investigate the association between office visits to medical specialists and health care spending. The data covered more than five years, from April 2012 through September 2017.

ACOs in which 40 to 45 percent of the patient visits were provided by a specialist had $1,129 lower annual spending per beneficiary than ACOs with a specialist visit proportion of less than 35 percent, and $752 lower annual spending per beneficiary than ACOs with a specialist visit proportion of 60 percent or more.

“This study provides an empirical backing to the idea that a balance between primary care providers and specialists in the delivery of care for ACO patients, especially high-risk patients with chronic conditions, appears to provide optimal cost savings, or lower expenditures, for these organizations,” Mr. Shetty says. “We speculated that would be the case, but I don’t think we anticipated $1,000 lower spending per patient in the more balanced ACOs.”

The researchers also found that as the proportion of specialist visits increased in an ACO, the number of emergency department visits, hospital discharges and skilled nursing facility discharges decreased.

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