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Abstract Details

Stroke Utilization and Outcomes Under Alternative Payment Models: A Systematic Review
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
174
This systematic review evaluates current evidence regarding the impacts of alternative payment models (APM) on stroke outcomes, spending, and utilization.
As stroke contributes an estimated $28 billion to US health care costs annually, APMs aim to improve outcomes and lower spending over fee-for-service (FFS) by aligning economic incentives with high value care.
We included all English-language quantitative studies that evaluated APM vs control group, typically FFS. Included studies report at least one clinical, utilization, or spending outcome specific to hemorrhagic or ischemic stroke. Five databases were searched from inception to February 11, 2020. Two authors working independently screened studies for inclusion, and assessed quality using the Newcastle-Ottawa Quality Assessment. Study heterogeneity precluded meta-analysis.
Of 4,875 studies screened, 36 high quality studies met inclusion criteria and were synthesized in the narrative review. Among studies that reported clinical outcomes (N=29), mortality or readmissions rates were worse in 4/12 studies of capitated payments but improved in 3/12 studies. Functional outcomes were worse in 1/2 studies of capitation and 1/2 studies of prospective payment system (PPS). Some quality metrics were worse in 1/2 studies of pay-for-performance payments. Among studies reporting spending outcomes (N=10), 3/4 studies of PPS reported increased spending, while 1/2 studies of risk-sharing models such as Accountable Care Organizations (ACO) and bundled payments (BPCI) and 2/3 studies of capitation reported decreased spending. Among studies reporting acute and post-acute care utilization (N=20), capitation and risk-sharing models generally decreased utilization, but effects were mixed in studies of PPS. ACOs (N=4) had evidence for decreased spending and no evidence of worse clinical outcomes.
While more evidence is needed, payment models that incentivize coordination of care across care settings, such as ACOs and bundled payments, show potential for lowering spending while maintaining or improving quality of care.
Authors/Disclosures
Kelby W. Brown, Jr., MD (UNC, Chapel Hill, NC)
PRESENTER 		An immediate family member of Mr. Brown has received personal compensation for serving as an employee of Trinity School of Durham and Chapel HIll.
No disclosure on file
Nada El Husseini, MD, FÂ鶹´«Ã½Ó³»­ (DUKE UNIVERSITY HOSPITAL) Dr. El Husseini has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. The institution of Dr. El Husseini has received research support from the DISCOVERY trial funded by the National Institute of Neurological Disorders and Stroke (NINDS)and the National Institute on Aging (NIA) (U19NS115388).- subcontract from MGH. The institution of Dr. El Husseini has received research support from American Heart Association. The institution of Dr. El Husseini has received research support from PCORI.