Abstract

Objectives: A key way that the Affordable Care Act sought to reduce health care costs in the U.S. was through the creation of Accountable Care Organizations (ACOs). ACOs consist of networks of care providers that come together and are held accountable for all care delivered to a given population under a contractual arrangement with Medicare. Recent studies show rapid reductions in readmissions to ACO hospitals, but little is known about what these hospitals do to decrease individual readmissions. In the study we compared what steps ACO hospitals have taken to decrease readmissions compared to steps taken by non-ACO hospitals.

Methods: This qualitative study was conducted in eight different health care markets throughout the U.S and describes special programs and initiatives employed by the hospitals in connection to nursing facilities. 64 interviews were conducted at 16 hospitals, of which 6 participated in the Shared Savings and/or the Pioneer ACO Program and ten did not participate in any ACO.

Results: Results indicate that ACO hospitals, to a larger extent than non-ACO hospitals, have introduced measures to improve care transitions and reduce readmissions. First, ACO hospitals have created tighter networks with a few preferred nursing facilities that are selected based on specific requirements, such as geographic dispersion and quality ratings. Second, within these preferred provider networks, ACO hospitals have increased communication and introduced formal, regularly held meetings. Third, ACO hospitals have developed explicit programs and initiatives that aim to identify high risk patients and ensure these patients receive the right level of care. While some of these initiatives were also seen at non-ACO hospitals, they were not as common nor as formalized.

Conclusions: ACO-hospitals have taken active measures to lower readmissions through creating narrower networks of preferred providers and formalized programs. These developments were not as obvious in non-ACO hospitals. Additional research is needed to find out which of the initiatives and measures are most effective in reducing readmissions.