PolicyLab

JAMA Pediatrics published an editorial by PolicyLab's Maggie Eisen and Dr. David Rubin titled “Breaking New Ground in Health Services Research: Effect of Attribution Length in a Pediatric Medicaid Accountable Care Organization." The editorial reviews recent research by Christensen and Payne that explores the relationship among attribution in a pediatric Medicaid accountable care organization (ACO), resource use, and cost within a pediatric Medicaid population. The study found that ACO attribution was correlated with decreases in the use of inpatient care resources and spending, particularly among children with multiple chronic conditions. The authors acknowledged, however, that the total ACO cohort had been reduced by 50% after 12 months and by 70% after 24 months and that the study did not control for social determinants. The editorial raises two critical questions for hospitals and health systems involved in pediatric Medicaid ACOs: First, what level of responsibility should we assume in sustaining patient engagement in the primary care medical home? Second, what types of efforts to maintain ACO attribution would yield a solid return on investment in a shared risk and shared savings environment?