Jonathan B. Jaffery

Medicare shared savings programs: Higher cost accountable care organizations are more likely to achieve savings

ABSTRACT In the United States, Medicare’s flagship Accountable Care Organization (ACO) program, the Medicare Shared Savings Program (MSSP), is under close scrutiny to improve healthcare quality and decrease costs. First-year measures, released in November 2014, reveal a wide range of financial and quality performance across MSSP participants. In this observational study, we used 2013 results for 220 participating ACOs to assess key characteristics associated with generating savings. ACOs with higher baseline expenditures were significantly more likely to generate savings than lower cost ACOs. Average quality scores for ACOs that successfully reported on quality were not different between organizations that did and did not generate savings. These findings suggest ACOs that had lower utilization prior to program enrollment are less likely to be rewarded in the current program. This has important policy implications for the MSSPs ability to attract and retain efficient ACOs and incent efforts to reduce waste and improve quality.

Identifying Optimal Chronic Kidney Disease Patient Education Web Sites: Assessing E-Health Technology by Content Area Experts

One in nine adults in the United States has chronic kidney disease (CKD). Randomized studies show electronic health (e-health) systems improve health outcomes in chronic disease. This study describes a systematic evaluation of available CKD Web sites. We evaluated Web sites for educating patients with CKD, focusing on three specific design issues: usability, quality, and content. Thirty Web sites were evaluated between April and July 2004. Cohen’s kappa and intraclass correlation of quartile rankings for two independent evaluators were calculated. Mean score for evaluator 1 was 7.293 (standard error 0.511) and for evaluator 2 was 8.189 (0.413). Cohen’s kappa for the 2 evaluators’ total scores for all 30 Web sites is 0.7671, and intraclass correlation is 0.7703. In general, results show that it is possible to identify Web sites more likely to provide a positive educational experience for CKD patients. Further evaluation is needed to investigate the utility of variably ranked Web sites as educational interventions.