10 Jahre Accountable Care Organizations in den USA: Impulse für Reformen in Deutschland?

Zusammenfassung

Ziele der Studie Ein Ziel des Patient Protection and Affordable Care Acts (ACA), auch als Obama-Care bekannt, war die Bremsung der Kostenentwicklung im staatlichen Medicare-System durch eine Übertragung der Verantwortung für Versorgungskosten und -qualität auf die Leistungserbringer. Hierfür wurde Leistungserbringern gestattet sich in Netzwerken zusammenzuschließen, in denen sie für eine definierte Population verantwortlich sind –Accountable Care Organizations (ACOs). Zehn Jahre nach der Einführung von ACOs wird die Auswirkung auf Versorgungskosten und -qualität untersucht, um mögliche Implikationen für eine Übertragung auf Deutschland abzuleiten.

Methodik In einem Mixed Methods-Ansatz wurde ein Rapid Review in Health System Evidence und PubMed durchgeführt. Per Snowballing-Verfahren wurden weitere Paper identifiziert. Eingeschlossen wurden Paper, die nach Screening des Abstracts Aussagen zur Kosten- und/oder Qualitätsentwicklung enthielten. Ausgeschlossen wurden Paper, welche sich nicht auf US-Medicare-ACOs bezogen. Die Ergebnisse wurden im Folgenden durch Interviews mit 16 Experten aus den USA überprüft.

Ergebnisse Für die Analyse wurden 60 Paper herangezogen, inklusive 6 Reports im Auftrag von oder direkt durchgeführt von US-Regierungsstellen sowie 3 vorhergegangene Reviews. Von den 60 Papern beinhalten 31 Aussagen zu Kostenentwicklung, 18 zu Qualitätsentwicklung sowie 11 zu beiden Aspekten. Die Studien zeigen überwiegend, dass ACOs Versorgungskosten senken können. Das Kostensenkungspotential von ACOs besteht sowohl im Vergleich zu historischen Versorgungsdaten der jeweiligen Population als auch im Vergleich zu nicht in ACOs versorgten Populationen, als auch im Vergleich zu Counterfactuals. Die Qualität der Versorgung ist hierbei mindestens gleich geblieben oder konnte gesteigert werden.

Schlussfolgerung ACOs haben in den USA das Ausgabenwachstum für Medicare gebremst, bei unveränderter oder sogar verbesserter Qualität. Daher sollte eine Übertragung auf Deutschland in Erwägung gezogen werden. Jedoch haben verschiedene Policies den Erfolg der ACOs eingeschränkt. Vor diesem Hintergrund sowie den Unterschieden zum deutschen Versorgungssystem bedarf es einer kritischen Reflektion der Steuerungsinstrumente vor Einführung von ACO ähnlichen Strukturen in Deutschland.

Abstract

Goal of the Study An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountability for a defined population – Accountable Care Organizations (ACOs). Ten years after the introduction of ACOs, this paper looks at the impact of ACOs both on quality of care and costs of care to assess if ACOs can be a model of care delivery for Germany.

Methods In a mixed-method approach, a rapid review was conducted in Health System Evidence and PubMed. This was supported with further papers identified using the snowballing-technique. After screening the abstracts, we included articles containing information on cost- and/or quality impact of US-Medicare-ACOs. The findings of the rapid review were challenged with 16 ACO-experts and stakeholder in the USA.

Results In total, we included 60 publications which incorporated 6 reports that were either conducted directly by governmental institutions or ordered by them, along with 3 previous reviews. Among these, 31 contained information on costs of care, 18 contained information on quality of care and 11 had information on both aspects. The publications show that ACOs reduced costs of of care. Cost reductions were achieved compared to historic costs, to populations not cared for in ACOs, and counterfactuals. Quality of care stayed the same or improved.

Conclusion ACOs contributed to slowing the cost growth in US Medicare without compromising quality of care. Thus, a transferal of this model of care to Germany should be considered. However, various policies have led to ACOs failing to unleash their full potential. Against this background, and against the background of stark differences between US Medicare and the German health care system, a critical reflection of the necessary policies underlying ACOs-like structures in Germany, needs to be undertaken.

Schlüsselwörter

Accountable Care Organizations - ACO - Integrierte Versorgung - Populationsbezogene Versorgung - Medicare

Key words

Accountable Care Organizations - ACO - Integrated Care - Population Health - Medicareonline publiziert 2022

Publication History

Article published online:
03 February 2022

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