Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs

Authors

Sunny C. Lin, Portland State UniversityFollow
Phyllis L. Yan, University of Michigan Medical SchoolFollow
Nicholas M. Moloci, University of Michigan Medical School
Emily J. Lawton, University of Michigan
Andrew M. Ryan, University of Michigan School of Public Health,
Julia Adler-Milstein, University of California, San FranciscoFollow
John M. Hollingsworth, University of Michigan Medical School and School of Public Health

Sponsor

Sunny Lin is supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) (Grant No. R36HS025875-01A1). Andrew Ryan is supported by a grant from the National Institute on Aging (Grant No. R01AG047932). Julia Adler-Milstein is supported by a grant from AHRQ (Grant No. 1R01HS025165-01A1). John Hollingsworth is supported by grants from AHRQ (Grant Nos. R01HS024728 and R01HS024525). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ or the National Institute on Aging.

Published In

Health Affairs

Document Type

Citation

Publication Date

2020

Abstract

Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs’ inability to prohibit out-of-network care limits their control over spending. To examine this possibility, we examined the association between out-of-network care and per beneficiary spending using national Medicare data for 2012–15. While there was no association between out-of-network specialty care and ACO spending, each percentage-point increase in receipt of out-of-network primary care was associated with an increase of $10.79 in quarterly total ACO spending per beneficiary. When we broke down total spending by place of service, we found that out-of-network primary care was associated with higher spending in outpatient, skilled nursing facility, and emergency department settings, but not inpatient settings. Our findings suggest an opportunity for the Medicare program to realize substantial savings, if policy makers developed explicit incentives for beneficiaries to seek more of their primary care within network.

Description

© 2020 Project HOPE—The People-to-People Health Foundation, Inc.

Locate the Document

https://doi.org/10.1377/hlthaff.2019.00181

DOI

10.1377/hlthaff.2019.00181

Persistent Identifier

https://archives.pdx.edu/ds/psu/32397

Citation Details

Lin, S. C., Yan, P. L., Moloci, N. M., Lawton, E. J., Ryan, A. M., Adler-Milstein, J., & Hollingsworth, J. M. (2020). Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs: An examination of the association between out-of-network care and per beneficiary spending using national Medicare data. Health Affairs, 39(2), 310-318.