Medicare's Specialty-Oriented Accountable Care Organization: First-Year Results For People With End-Stage Renal Disease

The Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model was the first Medicare specialty-oriented accountable care organization (ACO) model. We examined whether this model provided better results for beneficiaries with ESRD than primary care-based ACO models. We found significant decreases...

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Bibliographic Details
Published in:Health affairs (Millwood, Va.) Va.), 2022-06, Vol.41 (6), p.893-16
Main Authors: Ullman, Darin F, Boyer, Gregory J, Negrusa, Brighita, Hirth, Richard A, Wiens, Jennifer, Marrufo, Grecia
Format: Article
Language:English
Subjects:
Accountable care organizations
Beneficiaries
Catheterization
Catheters
Chronic conditions
Chronic illnesses
Disease
End-stage renal disease
First year
Government programs
Health care
Hemodialysis
Hospitalization
Hospitals
Kidney diseases
Medical instruments
Medicare
Mortality
Nephrology
Owners
Participation
Payments
Primary care
Statistical significance
Subpopulations
Venous access
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Summary:The Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model was the first Medicare specialty-oriented accountable care organization (ACO) model. We examined whether this model provided better results for beneficiaries with ESRD than primary care-based ACO models. We found significant decreases in Medicare payments ($126 per beneficiary per month), hospitalizations (5 percent), and likelihood of readmissions (8 percent) among beneficiaries with ESRD during the first year of alignment with the CEC Model and no impacts on these measures among beneficiaries with ESRD who were aligned with primary carebased ACOs, relative to fee-for-service Medicare beneficiaries. Neither the CEC nor primary care-based ACO models significantly reduced the likelihood of catheter use, but fistula use increased for CEC Model beneficiaries to levels just above statistical significance. Other populations with chronic conditions may benefit from the testing of a specialtyoriented ACO model. In addition, primary care-based ACOs may benefit from applying CEC Model strategies to high-need subpopulations. Last, the strategies that enabled ESRD Seamless Care Organizations to achieve reductions in hospitalizations and readmissions even without hospital participation as owners could inform physician-led ACOs' efforts to coordinate with hospitals in their areas.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2021.01856