Dive Brief:
- Most beneficiaries assigned to an accountable care organization seek specialty care outside of their assigned ACO, according to a study published recently in JAMA Internal Care.
- To do this study, researchers dug into Medicare claims data from 2010 to 2011, along with lists of physicians participating in ACO programs.
- The number of beneficiaries seeking outpatient specialty care providers outside their ACO was larger for higher-cost beneficiaries. The study also noted that 38% of Medicare spending billed by ACO physicians was for assigned beneficiaries.
Dive Insight:
While this data makes it clear that Medicare beneficiaries don't concern themselves with ACO boundaries, it doesn't say whether it's worth mounting initiatives to guide those beneficiaries back into the network. However, if the purpose of the network is to control costs, it seems likely that programs will arise to make in-network specialists more attractive, as under ACO contracts, it's likely those specialists will be less expensive to use.