Table 2. Estimated Changes in Medicare Shared Savings Program ACO-Assigned Beneficiaries, Utilization, and Expenditure Associated With Participation of FQHCs From Difference-in-Differences Analyses.
| Outcome | Baseline valuea | Estimated change (95% CI) | P value | Pretrend P valueb |
|---|---|---|---|---|
| Assigned beneficiaries, No. of person-years | ||||
| Total | 16 818.1 | 9594.1 (2249.4 to 16 938.8) | .01 | .68 |
| Dual eligible | 1095.5 | 872.9 (345.9 to 1399.8) | <.001 | .35 |
| Disabled | 2107.1 | 1137.6 (390.1 to 1885.1) | <.001 | .59 |
| Racial and ethnic minoritizedc | 2241.9 | 1350.8 (447.4 to 2254.1) | <.001 | .68 |
| Utilization, No. per 1000 person-years | ||||
| FQHC and RHC visits | 302.6 | 494.5 (254.0 to 735.0) | <.001 | .99 |
| Total primary care visits | 10 391.9 | 325.8 (−143.4 to 795.0) | .17 | .44 |
| Outpatient emergency department visits | 691.1 | 6.7 (−43.5 to 56.9) | .79 | .64 |
| Short-term acute care hospital discharges | 282.4 | 10.4 (−3.6 to 24.4) | .15 | .38 |
| Skilled nursing facility discharges | 59.1 | 5.0 (−0.6 to 10.6) | .08 | >.99 |
| Per-capita expenditure, $ | 10 559.5 | 169.0 (−157.6 to 495.5) | .31 | .47 |
| Quality, % | ||||
| Influenza immunization | 71.9 | 5.9 (1.4 to 10.4) | .01 | .44 |
| Tobacco use screening and cessation intervention | 76.8 | 11.8 (3.7 to 20.0) | .004 | .73 |
| Screening for depression and follow-up plan | 63.4 | 8.9 (0.5 to 17.4) | .04 | .87 |
| Colorectal cancer screening | 67.1 | 1.3 (−2.4 to 5.1) | .48 | .79 |
| Breast cancer screening | 71.8 | −0.8 (−3.8 to 2.1) | .57 | .48 |
| Depression remission at 12 mo | 10.4 | 3.2 (−4.5 to 10.8) | .42 | .89 |
| Diabetes control (glycated hemoglobin ≤9%) | 83.6 | 0.9 (−2.8 to 4.7) | .62 | .07 |
| Controlling high blood pressure | 72.2 | 0.8 (−1.6 to 3.1) | .52 | .65 |
Abbreviations: ACO, accountable care organization; FQHC, federally qualified health center; RHC, rural health clinic.
a
Means of outcomes across all pretreatment years among ACOs that included FQHCs during 2016 to 2022.
b
Pretrend tests report the P value from a joint F test that the estimated coefficients of up to 3 years before FQHC inclusions are equal and not statistically significant from zero.
c
Includes all beneficiaries who are American Indian or Alaska Native, Asian and Pacific Islander, Black, Hispanic, other (no additional information available for this group from the Centers for Medicare & Medicaid Services data), and unknown.