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Accountable Care Organizations Can Cut Low-Value Service Use

Greater reductions with higher than markets' mean baseline levels of low-value service use

MONDAY, Sept. 21, 2015 (HealthDay News) -- The Pioneer accountable care organization (ACO) program correlated with reductions in low-value services during its first year, according to a study published online Sept. 21 in JAMA Internal Medicine.

Aaron L. Schwartz, Ph.D., from Harvard Medical School in Boston, and colleagues compared use of low-value services between Medicare fee-for-service beneficiaries attributed to health care provider groups that entered the Pioneer program (ACO group) and other health care providers (control group). Low-value service use was examined before and after Pioneer ACO contracts began.

The researchers found that trends in the use of low-value services were similar for the ACO and control groups during the precontract period. There was a differential reduction of 0.8 low-value services per 100 beneficiaries for the ACO group in association with the first year of ACO contract (P < 0.001), corresponding to differential reductions of 1.9 percent in service quantity and 4.5 percent in spending on low-value services (P = 0.004). Greater service reductions were seen for ACOs with higher than their markets' mean baseline levels of low-value service use (−1.2 services per 100 beneficiaries; P < 0.001), compared with ACOs with use below the mean (−0.2 services per 100 beneficiaries; P = 0.41; P = 0.003 for test of difference between subgroups).

"Accountable care organization-like risk contracts may be able to discourage use of low-value services even without specifying services to target," the authors write.

Two authors reported consulting for the Medicare Payment Advisory Commission on use of measures for low-value care. One author disclosed being a partner in VBID Health which has a contract with Milliman to develop and market a tool to help insurers and employers quantify spending on low-value services.

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