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ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities.

Publication ,  Journal Article
Bleser, WK; Saunders, RS; Winfield, L; Japinga, M; Smith, N; Kaufman, BG; Crook, HL; Muhlestein, DB; McClellan, M
Published in: Health Aff (Millwood)
June 2019

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.

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Published In

Health Aff (Millwood)

DOI

EISSN

1544-5208

Publication Date

June 2019

Volume

38

Issue

6

Start / End Page

1011 / 1020

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Palliative Care
  • Organizational Innovation
  • Organizational Case Studies
  • Medicare
  • Interviews as Topic
  • Humans
  • Health Policy & Services
  • Health Expenditures
 

Citation

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Chicago
ICMJE
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Bleser, W. K., Saunders, R. S., Winfield, L., Japinga, M., Smith, N., Kaufman, B. G., … McClellan, M. (2019). ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities. Health Aff (Millwood), 38(6), 1011–1020. https://doi.org/10.1377/hlthaff.2019.00013
Bleser, William K., Robert S. Saunders, Lia Winfield, Mark Japinga, Nathan Smith, Brystana G. Kaufman, Hannah L. Crook, David B. Muhlestein, and Mark McClellan. “ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities.Health Aff (Millwood) 38, no. 6 (June 2019): 1011–20. 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 Aff (Millwood). 2019 Jun;38(6):1011–20.
Bleser, William K., et al. “ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities.Health Aff (Millwood), vol. 38, no. 6, June 2019, pp. 1011–20. Pubmed, doi:10.1377/hlthaff.2019.00013.
Bleser WK, Saunders RS, Winfield L, Japinga M, Smith N, Kaufman BG, Crook HL, Muhlestein DB, McClellan M. ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities. Health Aff (Millwood). 2019 Jun;38(6):1011–1020.

Published In

Health Aff (Millwood)

DOI

EISSN

1544-5208

Publication Date

June 2019

Volume

38

Issue

6

Start / End Page

1011 / 1020

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Palliative Care
  • Organizational Innovation
  • Organizational Case Studies
  • Medicare
  • Interviews as Topic
  • Humans
  • Health Policy & Services
  • Health Expenditures