Research Roundup: Value-Based Payment; ACOs; And Medicare Advantage

JAMA: Social/Medical Risk And Practice Performance In Medicare Value Modifier Program
Was there an association between the social or medical risk of patients treated at physician practices and performance during the first year of the Medicare Physician Value-Based Payment Modifier Program? Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices. As value-based payment programs continue to increase in size and scope, practices that disproportionately serve high-risk patients may be at particular risk of receiving financial penalties. (Chen, Epstein, Orav et al, 8/1)

JAMA Internal Medicine: Extending CareFirst’s Medical Home Program To Medicare Patients 
Does CareFirst’s medical home program, which provides financial incentives to primary care practices and care coordination for high-risk patients, improve quality of care and reduce hospitalizations, emergency department visits, and spending for Medicare patients? In a difference-in-differences analysis with 52 intervention practices and matched comparison practices, the program was not associated with outcome improvements for Medicare patients. Hospitalizations declined by 10%, but this was matched by similar changes in the comparison group, suggesting that outside market factors drove the decline in the treatment group. This medical home model needs further adaptions and testing before being scaled broadly for Medicare patients. (Peterson, Geonnotti, Hula et al, 7/31)

JAMA Cardiology: Changes In Medication Use And Adherence In Accountable Care Organizations
In this population-based study of Medicare beneficiaries from before the start of accountable care organization contracts to 2014, ranging from approximately 4.5 million to 10.8 million person-years, depending on drug class, differential changes in the use of and adherence to common antihypertensive, lipid-lowering, and hypoglycemic medications were minimal for accountable care organization patients vs patients of non–accountable care organization providers. Through its third year of operation, the Medicare Shared Savings Program has not meaningfully increased the use of or adherence to medications that improve outcomes for patients with cardiovascular disease or diabetes. (McWilliams, Najafzadeh, Shrank et al, 7/12)

The Henry J. Kaiser Family Foundation: Some Counties May Lack An ACA Marketplace Insurer Next Year – But Many More Lack Medicare Advantage Plans Today
With efforts to repeal and replace the Affordable Care Act (ACA) apparently on hold, some policymakers may ramp up efforts to strengthen the individual market, particularly in areas with few if any insurers. During the recent debate, a fair amount of attention was focused on counties at risk of having no health insurers in the ACA markets in 2018. As of July 31, 2017, 19 ACA marketplaces nested in mostly rural parts of Nevada, Indiana, and Ohio are at risk of having no insurer next year, according to the latest Kaiser Family Foundation analysis. Critics of the ACA say that the potential lack of insurers in these counties offers proof that the ACA is failing. But, does it? We analyzed these counties to see whether the story looks similar for Medicare Advantage plans, and found relatively few insurers offering Medicare Advantage plans in the counties that could have no exchange plans next year. In 7 of these 19 counties, there are no Medicare Advantage insurers, and in another 8 counties, there are two or fewer firms now offering a Medicare Advantage plan – well below the national average. (Jacobsen and Neuman, 8/1)