Table 3.
Pediatric Utilization Before and After Accountable Care Organization Implementation
| Variable | ACO population |
MCO population |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Baseline |
Program year 1 |
Program year 2 |
Baseline |
Program year 1 |
Program year 2 |
|||||
| 2015 | 2016 | 2017 | 2018 | 2019 | 2015 | 2016 | 2017 | 2018 | 2019 | |
| Population size (person-years) | 272,734 | 216,339 | 293,569 | 298,581 | 312,838 | 46,422 | 38,404 | 44,436 | 37,399 | 22,343 |
| Primary care visits | ||||||||||
| Number of visits per member per year | 4.7 | 4.7 | 4.8 | 5.0 | 4.7 | 3.8 | 4.7 | 4.6 | 4.7 | 4.9 |
| O:E ratio | 1.00 | 1.03 | 0.99 | 0.93 | 1.00 | 1.04 | ||||
| ED visits | ||||||||||
| Number of visits per 1000 members | 450.7 | 427.6 | 456.6 | 493.3 | 442.8 | 380.3 | 390.9 | 421.5 | 434.8 | 370.3 |
| O:E ratio | 1.01 | 1.11 | 1.00 | 0.91 | 0.99 | 0.83 | ||||
| Hospitalizations | ||||||||||
| Number of admissions per 1000 members | 23.9 | 21.3 | 21.7 | 21.5 | 20.9 | 18.8 | 17.3 | 17.0 | 15.1 | 16.5 |
| O:E ratio | 1.05 | 0.79 | 0.92 | 0.86 | 0.55 | 0.46 | ||||
| Readmissions | ||||||||||
| Number of readmissions per 100 discharges | 6.9 | 6.9 | 8.0 | 7.7 | 9.5 | 7.5 | 6.2 | 5.0 | 6.2 | 7.1 |
| O:E ratio | 0.99 | 0.90 | 0.98 | 0.93 | 0.73 | 0.67 | ||||
Notes: For the O:E ratio, observed is the calculated outcome for the quality measure; expected is calculated based on a model that accounts for changes in member characteristics (age and sex, disability, housing instability, and medical morbidity) between baseline (2015–2017) and 2018 and 2019. The ratio of O:E values varies around 1.0, with values <1 indicating lower than expected outcomes and values of >1 indicating greater than expected outcomes for the measure.
ACO, accountable care organization; ED, emergency department; MCO, managed care organization; O:E, observed-to-expected.