The cancer spending analysis, conducted by researchers at the Dartmouth Institute for Health Policy and Clinical Practice, is one of a limited number of studies to report results for an accountable care model and may offer some hope to a growing number of hospitals, clinics and insurers that have entered into ACOs with little proof they will work.
Accountable care arrangements typically offer financial incentives to hospitals and doctors to curb health spending and reach quality targets.
The paper also offers a glimpse into the economics of cancer care. New chemotherapy treatments that entered the market during the demonstration, which ran from 2005 to 2010, may have contributed to rising costs midway through the effort.
The savings were attributed to a drop in spending on hospital care; hospital discharges dropped.
Cancer-specific care did not change, and researchers seemed to be at a loss to explain the significance of that finding. “This could be viewed optimistically: Payment reform was not associated with stinting on cancer-specific treatment,” they wrote. “Alternatively, it may be disappointing that the (demonstration) did not induce changes in discretionary services (such as imaging), which are both expensive and common in cancer treatment.”
Overall, the demonstration did not reduce the number of cancer patients who died in the hospital. The Billings (Mont.) Clinic and the Dartmouth-Hitchcock Clinic, Bedford, N.H., saw fewer patients die in the hospital.
The remaining groups in the demonstration were Everett (Wash.) Clinic, Forsyth Medical Center, Winston-Salem, N.C.; Geisinger Health System, Danville, Pa.; Marshfield (Wis.) Clinic; Middlesex Health System, Middletown, Conn; Park Nicollet Health Service, St. Louis Park, Minn.; St. John's Health System, Springfield, Mo.; and the University of Michigan Faculty Group Practice, Ann Arbor.
Uncertainty regarding whether accountable care can deliver lower costs and quality without too much risk may be prompting some to delay development plans until more is known. One small survey by the not-for-profit consultants Purdue Healthcare Advisors found nearly half had no plans for an ACO. Of those, half said the reason was that there are too many questions about the model. The survey included responses from about 200 healthcare executives.
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