Aco serious illness care: Survey and case studies depict current challenges and future opportunities

William K. Bleser, Robert S. Saunders, Lia Winfield, Mark Japinga, Nathan Smith, Brystana G. Kaufman, Hannah L. Crook, David B. Muhlestein, Mark McClellan

Research output: Contribution to journalArticle

Abstract

Care for people living with serious illness is suboptimal for many reasons, including underpayment for key services (such as care coordination and social supports) in fee-for-service reimbursement. Accountable care organizations (ACOs) have potential to improve serious illness care because of their widespread dissemination, strong financial incentives for care coordination in downside-risk models, and flexibility in shared savings spending. Through a national survey we found that 94 percent of ACOs at least partially identify their seriously ill beneficiaries, yet only 8–21 percent have widely implemented serious illness initiatives such as advance care planning or home-based palliative care. We selected six diverse ACOs with successful programs for case studies and interviewed fifty-three leaders and front-line personnel. Cross-cutting themes include the need for up-front investment beyond shared savings to build serious illness infrastructure and workforce; supporting the business case for organizational buy-in; how ACO contract specifications affect savings for serious illness populations; and using data and health information technology to manage populations. We discuss the implications of the recent Medicare ACO regulatory overhaul and other policies related to serious illness quality measures, risk adjustment, attribution methods, supporting rural ACOs, and enhancing timely data access.

Original languageEnglish (US)
Pages (from-to)1011-1020
Number of pages10
JournalHealth Affairs
Volume38
Issue number6
DOIs
StatePublished - Jun 2019

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Accountable Care Organizations
Advance Care Planning
Risk Adjustment
Fee-for-Service Plans
Medical Informatics
Contracts
Medicare
Palliative Care
Social Support
Population
Surveys and Questionnaires
Motivation

ASJC Scopus subject areas

  • Health Policy

Cite this

Aco serious illness care : Survey and case studies depict current challenges and future opportunities. / Bleser, William K.; Saunders, Robert S.; Winfield, Lia; Japinga, Mark; Smith, Nathan; Kaufman, Brystana G.; Crook, Hannah L.; Muhlestein, David B.; McClellan, Mark.

In: Health Affairs, Vol. 38, No. 6, 06.2019, p. 1011-1020.

Research output: Contribution to journalArticle

Bleser, WK, Saunders, RS, Winfield, L, Japinga, M, Smith, N, Kaufman, BG, Crook, HL, Muhlestein, DB & McClellan, M 2019, 'Aco serious illness care: Survey and case studies depict current challenges and future opportunities', Health Affairs, vol. 38, no. 6, pp. 1011-1020. https://doi.org/10.1377/hlthaff.2019.00013
Bleser WK, Saunders RS, Winfield L, Japinga M, Smith N, Kaufman BG et al. Aco serious illness care: Survey and case studies depict current challenges and future opportunities. Health Affairs. 2019 Jun;38(6):1011-1020. https://doi.org/10.1377/hlthaff.2019.00013
Bleser, William K. ; Saunders, Robert S. ; Winfield, Lia ; Japinga, Mark ; Smith, Nathan ; Kaufman, Brystana G. ; Crook, Hannah L. ; Muhlestein, David B. ; McClellan, Mark. / Aco serious illness care : Survey and case studies depict current challenges and future opportunities. In: Health Affairs. 2019 ; Vol. 38, No. 6. pp. 1011-1020.
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