• Nicole M Benson, Mary Price, Christine Vogeli, Maryann M Vienneau, Mallika L Mendu, Amy Flaster, Lisa Balentine, Lindsay Jubelt, Gregg S Meyer, and John Hsu.
• McLean Hospital, Harvard Medical School, 115 Mill St, Belmont, MA 02478. Email: nbenson@mgh.harvard.edu.
• Am J Manag Care. 2023 Apr 1; 29 (4): e104e110e104-e110.

ObjectivesCommercial accountable care organization (ACO) contracts attempt to mitigate spending growth, but past evaluations have been limited to continuously enrolled ACO members in health maintenance organization (HMO) plans, excluding many members. The objective of this study was to examine the magnitude of turnover and leakage within a commercial ACO.Study DesignA historical cohort study using detailed information from multiple commercial ACO contracts within a large health care system between 2015 and 2019.MethodsIndividuals insured through 1 of the 3 largest commercial ACO contracts during the study period, 2015-2019, were included. We examined patterns of entry and exit and the characteristics that predicted remaining in the ACO compared with leaving the ACO. We also examined predictors of the amount of care delivered in the ACO compared with outside the ACO.ResultsAmong the 453,573 commercially insured individuals in the ACO, approximately half left the ACO within the initial 24 months after entry. Approximately one-third of spending was for care occurring outside the ACO. Patients who remained in the ACO differed from those who left earlier, including being older, having a non-HMO plan, having lower predicted spending at entry, and having more medical spending for care performed within the ACO during the initial quarter of membership.ConclusionsBoth turnover and leakage hamper the ability of ACOs to manage spending. Modifications that address potentially intrinsic vs avoidable sources of population turnover and increase patient incentives for care within vs outside of ACOs could help address medical spending growth within commercial ACO programs.

6 keywords...

hide…