Accountable care organisations - Sax Institute Health towards value-based healthcare and an emphasis

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  • Accountable care organisations

    An Evidence Check rapid review brokered by the Sax Institute for the NSW

    Agency for Clinical Innovation. April 2018.

  • An Evidence Check rapid review brokered by the Sax Institute for the NSW Agency for Clinical

    Innovation. April 2018.

    This report was prepared by:

    David Peiris, Madeline News, Kellie Nallaiah with support from an international expert advisory

    group (members: Stephen Jan, Carrie Colla, Alexander Pimperl, Oliver Groene, Julien Mosques, Tracy

    Johnson, and Daniel Northam-Jones).

    April 2018

    © Sax Institute 2018

    This work is copyright. It may be reproduced in whole or in part for study training purposes subject

    to the inclusions of an acknowledgement of the source. It may not be reproduced for commercial

    usage or sale. Reproduction for purposes other than those indicated above requires written

    permission from the copyright owners.

    Enquiries regarding this report may be directed to the:

    Principal Analyst

    Knowledge Exchange Program

    Sax Institute

    www.saxinstitute.org.au

    knowledge.exchange@saxinstitute.org.au

    Phone: +61 2 91889500

    Suggested Citation:

    Peiris D, News M, Nallaiah K, Accountable care organisations: an evidence check rapid review

    brokered by the Sax Institute for the NSW Agency for Clinical Innovation, 2018.

    Disclaimer:

    This Evidence Check Review was produced using the Evidence Check methodology in response to

    specific questions from the commissioning agency.

    It is not necessarily a comprehensive review of all literature relating to the topic area. It was current

    at the time of production (but not necessarily at the time of publication). It is reproduced for general

    information and third parties rely upon it at their own risk.

  • Accountable care organisations

    An Evidence Check rapid review brokered by the Sax Institute for the NSW Agency for Clinical

    Innovation, April 2018

    This report was prepared by David Peiris, Madeline News, Kellie Nallaiah.

  • 4 ACCOUNTABLE CARE ORGANISATIONS | SAX INSTITUTE

    Contents

    List of acronyms ......................................................................................................................................................................................... 6

    Executive summary.................................................................................................................................................................................... 7

    Background / Purpose of the review............................................................................................................................................. 7

    Review questions ................................................................................................................................................................................... 7

    Summary of methods .......................................................................................................................................................................... 7

    Key findings ............................................................................................................................................................................................. 7

    Applicability ............................................................................................................................................................................................. 9

    Conclusion ............................................................................................................................................................................................... 9

    Background ............................................................................................................................................................................................... 10

    Purpose .................................................................................................................................................................................................. 10

    Review questions ................................................................................................................................................................................ 10

    Methods ..................................................................................................................................................................................................... 11

    Definition ............................................................................................................................................................................................... 11

    Figure 1: Risk sharing in Accountable Care Organisation models ...................................................................................... 12

    Peer review literature ........................................................................................................................................................................ 12

    Inclusion/exclusion criteria ............................................................................................................................................................. 12

    Case study selection.......................................................................................................................................................................... 13

    ACO framework................................................................................................................................................................................... 13

    Table 1: Accountable care framework — component rankings according to level of maturity 1 ..................... 13

    Findings....................................................................................................................................................................................................... 15

    Database search.................................................................................................................................................................................. 15

    Question 2 ............................................................................................................................................................................................. 16

    Figure 4. Normalised distribution of expenditure outcomes for ACOs participating in the US Medicare

    Shared Savings Program* ............................................................................................................................................................... 18

    Figure 5. Correlation between per capita target benchmark and % savings for ACOs participating in the US

    Medicare Shared Savings Program (n=392) ........................................................................................................................... 19

    Figure 6: Relationship between quality scores and savings for 303 ACOs participating in the Medicare

    Shared Savings Program ................................................................................................................................................................. 20

    Table 2. Reported outcomes (68 of 146 models with available data) .......................................................................... 21

    Question 3 ............................................................................................................................................................................................. 22

    Discussion .................................................................................................................................................................................................. 25

    Structure ................................................................................................................................................................................................ 25

    Capability ............................................................................................................................................................................................... 26

    Outcomes .............................................................................................................................................................................................. 26

  • ACCOUNTABLE CARE ORGANISATIONS | SAX INSTITUTE 5

    Applicability............................................................................................................................................................................................... 28

    Table 3: Comparison of NSW Integrated Care Strategy, Health Care Homes and ACOs ..................................... 28

    Figure 7 — Ten building blocks of high-performing primary care50 ............................................................................ 31

    Considerations for ACO adoption in NSW .............................................................................................................................. 31

    Conclusion ................................................................................................................................................................................................. 34

    References .