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Does Beneficiary Switching Create Adverse Selection For Hospital-Based ACOs?

Does Beneficiary Switching Create Adverse Selection For Hospital-Based ACOs?

Despite the many uncertainties in the current health care delivery environment, payers and providers continue to demonstrate considerable interest in alternative payment models, including Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). HIP Investigator, Dr. Maureen Smith et al. believe that there is an alternative explanation for hospital-based ACOs’ seemingly poorer financial performance. Specifically, as Medicare beneficiaries develop new and more complex diseases, the increased utilization they require leads them to facilities that have more specialized care, which may more likely be part of a hospital-based ACO than a physician-led one.

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