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VBP Models Linked to Lower Acute Care Use

Study shows value-based payment models significantly associated with lower acute care use

March 30, 2022  – A new study published in JAMA Network Open shows that Medicare Advantage beneficiaries with a primary care organization participating in a value-based payment model saw a lower rate of observation stays, ER visits, and hospitalizations.

Study Methodology

The study, spearheaded by Suhas Gondi, BA, identified beneficiaries enrolled in plans provided by large Medicare Advantage organizations from 2017 to 2019. These beneficiaries were then categorized by the payment model their primary care organization follows; fee for services (FFS), shared savings with upside-only financial risk (upside-only risk) and shared savings with two-sided risk. (2-sided risk).  

Claims data was then used to identify observation stays, ER visits, and hospitalizations throughout 2019. Outcomes were segmented into avoidable and all-cause events and a quasi-Poisson regression model was used to estimate association. 

Results Show Value-Based Payment Models Linked to Lower Acute Care Use

Results from the study with a population of 489,796 MA beneficiaries show that those with value-based payment models were associated with lower acute care use. 

One glaring example looks at the overall rate of emergency department visits. For VBP models, it was 37.6% compared to 43.3% with FFS models. The link between value-based payment models and acute care use was even more distinguishable for avoidable acute care use.  VBP models were associated with a 15.6% reduction in avoidable hospitalizations. This compares to only a 4.2% reduction for all-cause hospitalizations.

Overall, the study is consistent with other analyses that evaluate value-based payment models and their ability to improve patient health outcomes. 

“Our findings suggest that organizations engaging in advanced value-based payment models in MA deliver differential outcomes to the MA beneficiaries under their care,” the study stated.

To read the full study, click here.

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