Top 5 Most-Read AJAC Articles of 2018

In 2018, articles in The American Journal of Accountable Care^® (AJAC) analyzed experiences within accountable care organizations (ACOs), the cost-effectiveness of initiatives to prevent readmissions, and much more. Here are the top 5 most-read articles published in AJAC in 2018.

5. A Managed Care Organization's Call Center—Based Social Support Role

According to this case study, a managed care organization has found success in addressing members’ social determinants of health by offering assistance from CommUnity Liaisons, who are laypeople trained to answer calls from participants in need of family support, transportation, and housing assistance. Interviews with stakeholders confirmed that the CommUnity Liaisons provided informational support to members through advice, suggestions, and helpful information.

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4. Thirty-Day Readmissions: Relationship to Physician Attending Type and Social Connectedness

As more health providers are recognizing loneliness as a major determinant of health outcomes, a retrospective cohort study confirms that patients with lower social connectedness were more likely to be readmitted after a hospitalization for congestive heart failure, chronic obstructive pulmonary disease, or pneumonia. Conversely, those who were admitted to the hospital by a geriatrician were less likely to be admitted, pointing to the importance of enhanced care coordination.

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3. Cost-Effectiveness of Pharmacist Postdischarge Follow-Up to Prevent Medication-Related Admissions

Having pharmacists contact patients within 72 hours of discharge to identify and resolve medication-related problems was a cost-effective method of reducing readmissions and costs, this analysis found. The 30-day readmission rates were 16.2% for patients receiving the follow-up calls and 21.6% for those receiving usual care, and average costs per patient were $3433 and $4014, respectively. The study authors suggest that the program could yield cost savings for hospitals operating in a capitated model or being reimbursed based on population health.

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2. Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings

An analysis of spending patterns among ACOs in the Medicare Shared Savings Program (MSSP) finds that categories of expenditures are shifting over time, and these shifts may be associated with financial savings. MSSP ACOs that are spending a smaller proportion of money on inpatient and postacute care services and a greater proportion on services in the physician office and hospice settings are seeing more savings, according to the researchers. They called for further research into how ACOs may achieve reductions in spending without sacrificing quality.

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1. ACO Quality Over Time: The MSSP Experience and Opportunities for System-Wide Improvement

Another analysis by some of the authors of the previous study looked into changes in quality among MSSP ACOs. They found that quality improved over time despite the ACOs’ older, sicker populations, which indicates that such a model could succeed in other settings or populations. The findings suggest that quality improvement efforts may be boosted by allocating sufficient infrastructure funding, building good relationships with postacute care facilities, and learning from the experiences of diverse ACOs.

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