Study: Fragmented Health Care System Could Hamper Medicare ACOs

The Affordable Care Act encourages care coordination as a strategy to lower costs and improve outcomes through the creation of Medicare accountable care organizations, but deep fragmentation in the health system poses challenges to reaching these goals, according to a study published Monday in JAMA Internal Medicine, the Washington Post's "Wonkblog" reports.

For the study, J. Michael McWilliams of Harvard Medical School and colleagues examined Medicare claims and physician rosters from 525,000 beneficiaries from 2010 and 2011, who received care from 145 provider groups that eventually formed ACOs two years later. The researchers examined data showing how beneficiaries sought out care and whether they went to providers that would eventually be part of the same ACO.

The study found that about 80% of the beneficiaries would have received a larger proportion of their care from providers within the same ACO in 2010 and 2011. However, beneficiaries were more likely to stay with the same primary care physicians than the same specialists. The study also found that 8.7% of the beneficiaries sought care from a PCP that would have been outside the ACO network, while nearly 66% would have sought care from non-ACO specialists.

The study noted that patients more likely to seek care outside of the hypothetical ACOs included those with chronic conditions, who are most likely to benefit from coordinated care.

While the results are hypothetical, McWilliams noted that fragmented care in the current Medicare system could become a hurdle for Medicare ACOs. He said that beneficiaries currently are free to choose their physicians.

However, McWilliams pointed to current efforts to encourage patients to stay within ACOs, including a congressional advisory group that is looking into the issue (Millman, "Wonkblog," Washington Post, 4/21).