Study finds ACO care management and coordination services not associated with better outcomes for complex patients

A recent study from The Dartmouth Institute for Health Policy and Clinical Practice found that accountable care organization (ACO) care management and coordination activities were not associated with improved outcomes or spending in patients with complex needs.

The study, published in JAMA, examined self-reported data from 244 Medicare Shared Savings Program (MSSP) ACOs based on claims from 2016. These ACOs were ranked into tertiles based on their care management and coordination capacity. The study defined a patient with complex needs as a Medicare beneficiary aged 66 years or older with frailty or two or more chronic conditions associated with high costs and clinical needs. It then examined whether patients within ACOs ranking in the top tertile for care management services performed better on outcome and spending measures (such as 30-day all-cause readmissions measures, median inpatient days, median annual spending, etc.) than patients within ACOs ranking in the bottom tertile.

The study found no statistically significant difference between top tertile ACOs and bottom tertile ACOs in outcome and payment measure performance for complex patients. The study authors acknowledged that the cross-sectional nature of the study created a significant limitation in determining causation, and there was no way to adjust for ACOs with higher levels of care management services whose patients may have been sicker than in other ACOs.

Still, the study authors encouraged those involved in future efforts to care for patients with complex needs to assess whether strategies found to be effective in other settings are being used. If so, it is important to determine why the same strategies do not appear to meet expectations in these ACOs.