Searching for the Policy-Relevant Treatment Effect in Medicare’s ACO Evaluations

AJMC December 9, 2024
Bryan E. Dowd, PhD,Roger D. Feldman, PhD,Woolton Lee, PhD,Kathleen Rowan, PhD,Shriram Parashuram, PhD,Katie White, EdD, MBA

The authors discuss multiple challenges to the production of policy-relevant results from evaluation of Medicare accountable care organizations (ACOs).

ABSTRACT

Objectives: To explain key challenges to evaluating Center for Medicare and Medicaid Innovation (CMMI) accountable care organization (ACO) models and ways to address those challenges.

Study Design: We enumerate the challenges, beginning with the conception of the alternative payment model and extending through the decision to scale up the model should the initial evaluation suggest that the model is successful. The challenges include churn at the provider and ACO levels, beneficiary leakage and spillover, participation in prior payment models, and determinants of shared savings and penalties.

Methods: We explain challenges posed in evaluations of voluntary ACO models vs models in...

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