Medicare Risk Arrangement and Use and Outcomes Among Physician Groups.

ABSTRACT:

Importance

Many physician groups are in 2-sided risk payment arrangements with Medicare Advantage plans (at-risk MA). Analysis of quality and health resource use under such arrangements may inform ongoing Medicare policy concerning payment and service delivery.

Objective

To compare quality and efficiency measures under 2 payment models: at-risk MA and fee-for-service (FFS) MA.

Design, setting, and participants

This cross-sectional study used Medicare encounter and enrollment data from 2016 to 2019 covering 17 physician groups, 15 488 physicians, and 35 health insurers to compare quality and health resource use for Medicare beneficiaries within the same physician groups. The data were analyzed between August 4 and October 30, 2024.

Exposures

Care delivered under

SUBMITTER: Cohen KR 

PROVIDER: S-EPMC11758596 | biostudies-literature | 2025 Jan

REPOSITORIES: biostudies-literature