Studies and Reports

Physicians Provide Higher Quality Care Under Set Monthly Payments

August 2020

A study from UnitedHealth Group found that primary care physicians paid under global capitation achieve key quality metrics at higher rates than those paid under fee-for-service. The findings of the study highlight that capitation provides the right incentives for value-based care.

Physician-Led ACOs Outperform Hospital-Led Counterparts

October 2019

New analysis from Avalere finds that physician-led accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) outperformed hospital-led ACOs by a significant margin. Avalere’s analysis found that the low-revenue, physician-led ACOs performed significantly better than the high-revenue, hospital-led ACOs. On average, physician-led ACOs produced almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACOs 

Spread of ACOs and Value-Based Payment Models in 2019: Gauging the Impact of Pathways to Success

October 2019

A slightly higher percentage of physician-led ACOs, compared to ACOs led by hospitals, are taking on downside risk (32 versus 27 percent). This is promising, as there have been concerns that physician groups would be reluctant to move toward downside risk due to smaller financial reserves.

Medicare Spending After 3 Years of the Medicare Shared Savings Program

September 2018

Using fee-for-service Medicare claims from 2009 through 2015, we performed difference-in-differences analyses to compare changes in Medicare spending for patients in ACOs before and after entry into the MSSP with concurrent changes in spending for local patients served by providers not participating in the MSSP (control group). We estimated differential changes (i.e., the between-group difference in the change from the pre-entry period) separately for hospital-integrated ACOs and physician-group ACOs that entered the MSSP in 2012, 2013, or 2014.

After 3 years of the MSSP, participation in shared-savings contracts by physician groups was associated with savings for Medicare that grew over the study period, whereas hospital-integrated ACOs did not produce savings (on average) during the same period.

Changes in Medicare  Shared Savings Program Savings from 2013 to 2014

October 2016

In subgroup analyses, spending reductions in 2014 were driven largely by ACOs with baseline spending above their region’s average and by independent physician groups without financial ties to hospitals

Early Performance of Accountable Care Organizations

June 2016

Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P=0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others.

Defining Accountable Care in the Age of ACOs

July 2014

Since 2012, physician-led ACOs have grown 138%—nearly 1.4 times more than hospital-sponsored ACOs.10 Approximately 51% of ACOs are physician-led, while 33% are hospital-sponsored.11 Shortly after introduction of the ACO model, physician-led ACOs were commonly viewed as disadvantaged because of their typically small size, lack of capital, and inattention to systematic quality improvement. However, research by Farzad Mostashari, MD, former National Coordinator for Health IT, showed that 29% of physician-led ACOs earned savings in their first MSSP year compared with fewer than 20% of hospital-sponsored ACOs.12

Dr Mostashari explains why physician-led ACOs are well-suited for meeting MSSP requirements: “Hospital-sponsored ACOs must contend with ‘demand destruction’ on their fee-for-service lines of business if they reduce procedures, admissions, and emergency department visits. However, physician-led ACOs are not similarly encumbered, and this model provides them with a ‘safe’ transitional path toward taking risk.”13