What is the comparative effectiveness of different models of shared risk for ACOs on improving patient-centered outcomes?

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Breakout Group Questions

Accountable Care Organizations

1. ACO Structures and Risk Sharing Arrangements:

 How do different models of ACOs (e.g., ownership, structural, risk) compare in their ability to improve patient-centered care, e.g., access to appropriate care, improved care coordination, improved care experiences, and health outcomes?

 What is the comparative effectiveness of different models of shared risk for ACOs on improving patient-centered outcomes?

 Structure aside, what components or key activities of ACOs (e.g., data sharing capacity, or performance management systems) are most effective for improving patient-centered outcomes?

What characteristics of an ACO’s structure and risk-profile are important to measure when conducting comparative effectiveness research in order to define the comparators? What other characteristics and qualities other than the “model” are important to measure (e.g., closed versus open networks, degree of ACO market penetration)?

Which, if any, models of ACOs are the most relevant comparators in the private sector?

For questions that seem the most compelling for PCORI to support, how would you re-word these questions so they better address a patient-centered comparative effectiveness question?

-Which populations (or subpopulations) should be targeted?

-What are the appropriate interventions and comparators? (What specific ACO models should be evaluated?)

-What are the relevant patient-centered outcomes?

Why or why not are these questions particularly well-suited for PCORI to fund?

If you have developed more than one question – which of these are most compelling and why? What are the challenges raised in conducting research on these questions, and how might those challenges be addressed?

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2. Patient and Provider Activation

 Are different models of patient engagement in ACOs better at improving patient-centered outcomes than others? Are different models of patient engagement more effective for different subpopulations (e.g., children versus adults, socioeconomic status)?

 Do ACO models with up-front patient assignment or empanelment perform differently than those with retroactive patient attribution on quality of patient care, patient experience, and patient-centered outcomes?

 Which models of provider engagement in ACOs are better at improving patient-centered outcomes than others?

 How do different models of distributing risk and shared savings among providers within an ACO (e.g., primary care, secondary care, hospitals) affect practice changes and patient-centered outcomes?

 What are the most effective mechanisms to communicate CER findings, promote evidence-based care, and affect practice change within an ACO model? What is the impact of this on patient experience with care and patient-centered outcomes?

What is meant by patient activation within an ACO, and why is it important? What types of approaches have ACOs used to improve patient activation? What is meant by provider activation within an ACO, and why is it important?

What types of approaches have ACOs used to improve provider activation and affect practice change? Given the above, please word one or more questions so it more specifically reflects a patient-centered comparative effectiveness question:

-What are the appropriate interventions and comparators? (What specific types of interventions should be evaluated?)

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3. Delivery Services

 Which components of ACOs are driving the biggest changes/have the largest impact on improving patient-centered outcomes for high-risk, beneficiaries with chronic disease?

 Which arrangements for care coordination and care management within ACOs have the

largest benefit for long-term (5-year) beneficiary health on high-risk, beneficiaries with chronic disease?

 Are ACOs that have adopted more team-based care more effective than others that have

not in improving patient-centered outcomes for high-risk, beneficiaries with chronic disease?

 What is the comparative effectiveness research of different ACO models in terms of encouraging activation and use of preventive services? What is the impact on patient-centered outcomes?

What approaches are used by ACOs to improve patient-centered outcomes in the high-risk population with chronic disease?

What approaches are used by ACOs to encourage the use of preventive services?

Given the above, please word one or more questions so it more specifically reflects a patient-centered comparative effectiveness question:

-What are the appropriate interventions and comparators? (What specific components or approaches should be evaluated?)

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4. Medicaid

 How well have Medicaid ACOs performed on patient-centered outcomes relative to Medicaid Managed Care?

 Are Medicaid ACOs more effective than traditional Medicaid Managed Care in reducing health disparities?

 What are the best mechanisms to integrate traditional carve-out services into Medicaid ACOs to improve patient-centered outcomes?

o Long-term services and support o Behavioral and mental health o Social services

Why, or why not, is this a good time to evaluate Medicaid ACOs? Is Medicaid Managed Care the appropriate comparator for this market?

How would you characterize and classify the evolving models of Medicaid ACOs? For the second question, are these the appropriate carve-out services to include? What mechanisms are being used to better integrate these services into the ACO?

Given the above, please word one or more questions in the area of Medicaid ACOs so it more specifically reflects a patient-centered comparative effectiveness question:

-What are the appropriate interventions and comparators? (What specific components or approaches should be evaluated?)

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Populations of interest:

- People with chronic or complex illnesses; - People with low incomes;