Effective Care Management by Next Generation Accountable Care Organizations

Neal O'Hara
Olivia C Tran
Shantanu Phatakwala
Anita Cattrell
Youssef Ajami
Peer-Reviewed Article
July 2020

Complex care management programs implemented by Next Generation Accountable Care Organizations (NGACOs) have shown some success in recent years, but there have been few examples of programs demonstrating lower medical costs and utilization. This large-scale, multisite study of five NGACOs analyzes the impacts of a standardized complex care management program on utilization and spending for high-risk Medicare beneficiaries over two years.

Among the 1,897 matched pairs of the intervention and control groups, participants in the complex care program saw reductions for inpatient admissions and total medical expenditures (approximately 21 and 22 percent, respectively). These reductions were consistent across all five NGACOs, which suggests that the findings may be generalizable to other accountable care organizations.

Several program elements were associated with intervention fidelity, including the use of sophisticated predictive risk stratification analytics to identify and target patients, in-person visits from care managers, and timely initiation of care planning.

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