Achieving Accountable Care: Are We on the Right Path?

Based on the Commonwealth Fund Commission on a High Performance Health System's ten recommendations, highlights considerations for the Centers for Medicare and Medicaid Services in finalizing rules for the Shared Savings Program, slated to begin in 2012

High Performance Accountable Care: Building on Success and Learning From Experience

Presents the rationale for creating accountable care organizations, promising models, and the Commonwealth Fund Commission on a High Performance Health System's recommendations for implementing ACOs widely to achieve improved quality and efficiency

Convergence in health care spending across counties in New York from 2007 through 2016.

BackgroundOne approach considered for reducing health care spending is to narrow the gap in spending between high- and low-spending areas. The goal would be to reduce spending in the high areas to similar levels achieved in areas that use health care more efficiently. This paper examined the degree to which high-spending areas remain high-spending and which types of service lead to convergence or divergence in spending in New York State.MethodsThis analysis utilized publicly available data on county-level spending trends for the Medicare fee-for-service population from 2007 to 2016. The study applied methods previously used to evaluate changes in the regional variation of health care spending nationally to county-level data within New York.ResultsThe spread of health care spending converged slightly over the ten-year period analyzed. There was also evidence for regression to the mean-effects and changes in the relative rankings of spending across counties during this time. While there was strong evidence for convergence, many high-spending counties in 2007 remained high-spending in 2016. There were also differences in which services drove spending variation at the national level compared to within New York.ConclusionsThese findings point to counties with consistently high spending as a potential focus for health care cost-control efforts. Moreover, efforts to reduce unwarranted variation in spending may need to be tailored to the circumstances of particular regions as there are geographic differences in which services drive spending variation. Regression to the mean effects also have important implications for the specifications of alternative provider payment models, such as accountable care organizations, which promote convergence in spending by utilizing spending targets

Payments from drug companies to physicians are associated with higher volume and more expensive opioid analgesic prescribing.

BACKGROUND:While the rise in opioid analgesic prescribing and overdose deaths was multifactorial, financial relationships between opioid drug manufacturers and physicians may be one important factor. METHODS:Using national data from 2013 to 2015, we conducted a retrospective cohort study linking the Open Payments database and Medicare Part D drug utilization data. We created two cohorts of physicians, those receiving opioid-related payments in 2014 and 2015, but not in 2013, and those receiving opioid-related payments in 2015 but not in 2013 and 2014. Our main outcome measures were expenditures on filled prescriptions, daily doses filled, and expenditures per daily dose. For each cohort, we created a comparison group that did not receive an opioid-related payment in any year and was matched on state, specialty, and baseline opioid expenditures. We used a difference-in-differences analysis with linear generalized estimating equations regression models. RESULTS:We identified 6,322 physicians who received opioid-related payments in 2014 and 2015, but not in 2013; they received a mean total of $251. Relative to comparison group physicians, they had a significantly larger increase in mean opioid expenditures ($6,171; 95% CI: 4,997 to 7,346), daily doses dispensed (1,574; 95%CI: 1,330 to 1,818) and mean expenditures per daily dose ($0.38; 95$40. Relative to comparison physicians, they also had a larger increase in mean opioid expenditures ($1,031; 95$0.06; 95% CI: 0.002 to 0.13). CONCLUSIONS:Our findings add to the growing public policy concern that payments from opioid drug manufacturers can influence physician prescribing. Interventions are needed to reduce such promotional activities or to mitigate their influence

Setting a research agenda for medical overuse

Although overuse in medicine is gaining increased attention, many questions remain unanswered. Dan Morgan and colleagues propose an agenda for coordinated research to improve our understanding of the proble