No synergy of values-based programs for primary care organizations

Ideally, value and technology-based programs combine to produce better results. But researchers at the University of California, San Francisco found little evidence of synergy in the meaningful use, patient-centered medical home and Medicare Shared Savings Program ACO program.

According to a study published this week in JAMA Health Forum.

A research team led by Julia Adler-Milstein, Ph.D., professor of medicine and director of the Center for Clinical Informatics and Improvement Research at the University of California, San Francisco, examined the effects of participation in the use significant contribution from the CMS program, the National Committee for Quality Assurance’s home medical center program, and the ACOs from the Medicare Shared Savings Program (MSSP). Specifically, they examined whether participation in the programs had positive effects on preventable hospitalizations, adherence to evidence-based guidelines, and expenditures.

The complicated research, which involved evaluating the programs individually and in various combinations, showed that participation in all three programs was associated with a modest increase in diabetes guideline compliance and acute care spending, but this was also true participation in a single program. .

“Collectively, these results suggest that there is no systematic program synergy, at least not with the outcomes examined, Adler-Milstein and colleagues wrote.

The data they looked at came from almost 48,000 primary care organizations and the results were for 2009, 2010 and 2015-2017.

Participation in the meaningful use program was highest: 23.5% of primary care organizations participated for one to two years and an additional 37% for three to six years.

But only 1.4% of primary care organizations have participated in the patient-centered medical homes program for three to six years.

The researchers noted that a large proportion of primary care organizations avoided enrolling in the programs altogether: 39.7% did not participate in the meaningful use program, 78.3% did not participate in the MSSP ACO program and 97.4% did not participate in the patient-centered medical home program.

The programs examined in the study were not entirely ineffective. For example, participation in the MSSP ACO program, alone or in tandem with the Meaningful Use program, resulted in some reduction in Medicare spending. The reduction was qu8tesmall, however. Organizations that participated in both the MSSP and meaningful programs reduced their expenses and realized savings of only 0.51% ($33.89 less expenses per beneficiary per year).

The patient-centered home medicine program was the most effective program for meeting diabetes guidelines.

Overall, the researchers said their findings should prompt policymakers to think about how programs to transform primary care might be better aligned. They said the separation of technological efforts and those targeting improvement processes must be addressed.

“Without more explicit efforts to synchronize EHR (electronic health record) capabilities with the activities needed to deliver high-quality, low-cost primary care, it will be difficult for PCOs (primary care organizations) to derive substantial benefits of participating in multiple programs,” they said. wrote.

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