Changes in Specialty Care Use and Leakage in Medicare Accountable Care Organizations

AJMC May 3, 2018
Michael L. Barnett, MD, MS, and J. Michael McWilliams, MD, PhD

Reducing specialty leakage is promoted as crucial for accountable care organizations (ACOs). This study finds that Medicare ACOs had modest reductions in specialty use and minimal changes in leakage.

ABSTRACT

Objectives: Reducing leakage to outside specialists has been promoted as a key strategy for accountable care organizations (ACOs). We sought to examine changes in specialty care leakage and use associated with the Medicare Shared Savings Program (MSSP).

Study Design: Analyses of trends in ACOs from 2010 to 2014 and quasi-experimental difference-in-differences analyses comparing changes for ACOs versus local non-ACO providers from before until after the start of ACO contracts, stratified by ACO specialty composition and year of MSSP entry.

Methods: We used Medicare claims for a 20% sample of beneficiaries...

Today's Sponsors

Today's Sponsor