{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:36:13Z","timestamp":1790825773721,"version":"4.1.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi241571-4\"><jats:title>Importance<\/jats:title><jats:p>Many physician groups are in 2-sided risk payment arrangements with Medicare Advantage plans (at-risk MA). Analysis of quality and health resource use under such arrangements may inform ongoing Medicare policy concerning payment and service delivery.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241571-5\"><jats:title>Objective<\/jats:title><jats:p>To compare quality and efficiency measures under 2 payment models: at-risk MA and fee-for-service (FFS) MA.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241571-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study used Medicare encounter and enrollment data from 2016 to 2019 covering 17 physician groups, 15\u202f488 physicians, and 35 health insurers to compare quality and health resource use for Medicare beneficiaries within the same physician groups. The data were analyzed between August 4 and October 30, 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241571-7\"><jats:title>Exposures<\/jats:title><jats:p>Care delivered under at-risk MA and FFS MA payment arrangements by the same physicians and medical groups.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241571-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Twenty quality and efficiency measures across 4 domains of patient care (hospital care, avoidance of the emergency department [ED], avoidance of disease-specific admissions, and outpatient care) were examined using logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241571-9\"><jats:title>Results<\/jats:title><jats:p>The overall sample comprised 5\u202f278\u202f717 person-years (37.7% at-risk MA and 62.3% FFS MA). The mean (SD) age of beneficiaries was 73.6 (9.2) years in the at-risk MA group (56.8% women) and 71.8 (10.4) years in the FFS MA group (57.4% women). For at-risk MA compared with FFS MA, inpatient admissions and 30-day readmissions per 1000 were 10.03 (95% CI, \u221210.61 to \u22129.44) and 1.95 (95% CI, \u22122.18 to \u22121.73) lower. ED use measures per 1000 ranged from 2.95 (95% CI, \u22123.28 to \u22122.63) lower for avoidable ED visits to 26.02 (95% CI, \u221226.92 to \u221225.12) lower for overall ED visits. Avoidance of disease-specific admissions per 1000 ranged from 0.24 (95% CI, \u22120.35 to \u22120.13) lower for composite diabetes-related admissions to 2.18 (95% CI, \u22122.43 to \u22121.94) lower for the composite of chronic disease\u2013related admissions. High-risk drug use per 1000 was 14.26 (95% CI, \u221214.85 to \u221213.67) lower. Overall, compared with FFS MA, at-risk MA was associated with higher quality and efficiency in 18 of 20 measures after adjusting for differences in demographics, Hierarchical Condition Categories Risk Adjustment Factor scores, and other health characteristics.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi241571-10\"><jats:title>Conclusions and relevance<\/jats:title><jats:p>In this cross-sectional study, at-risk MA payment arrangements managed by physician groups were associated with higher quality and efficiency compared with FFS MA managed by the same groups. The population and methods used provide robust evidence that at-risk payment arrangements in MA may improve health care delivery for the MA population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.56074","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T16:32:15Z","timestamp":1737649935000},"page":"e2456074","source":"Crossref","is-referenced-by-count":3,"title":["Medicare Risk Arrangement and Use and Outcomes Among Physician Groups"],"prefix":"10.1001","volume":"8","author":[{"given":"Ken R.","family":"Cohen","sequence":"first","affiliation":[{"name":"Optum Center for Research and Innovation, Minnetonka, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Vabson","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Podulka","sequence":"additional","affiliation":[{"name":"America\u2019s Physician Groups, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan J.","family":"Smith","sequence":"additional","affiliation":[{"name":"CareJourney by Arcadia, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Everhart","sequence":"additional","affiliation":[{"name":"CareJourney by Arcadia, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Ameli","sequence":"additional","affiliation":[{"name":"Optum Center for Research and Innovation, Minnetonka, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kierstin","family":"Catlett","sequence":"additional","affiliation":[{"name":"Optum Center for Research and Innovation, Minnetonka, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan S.","family":"Jarvis","sequence":"additional","affiliation":[{"name":"Optum Center for Research and Innovation, Minnetonka, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Goldzweig","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical Network, Los Angeles, California"},{"name":"Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie H.","family":"Kuo","sequence":"additional","affiliation":[{"name":"Hill Physicians Medical Group, San Ramon, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Dentzer","sequence":"additional","affiliation":[{"name":"America\u2019s Physician Groups, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"issue":"6","key":"zoi241571r3","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1377\/hlthaff.2020.02149","article-title":"Comparing Medicare Advantage and traditional Medicare: a systematic review.","volume":"40","author":"Agarwal","year":"2021","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"zoi241571r4","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1257\/app.20170295","article-title":"Health care spending and utilization in public and private Medicare.","volume":"11","author":"Curto","year":"2019","journal-title":"Am Econ J Appl Econ"},{"issue":"1","key":"zoi241571r5","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1257\/pol.20160068","article-title":"The consequences of health care privatization: evidence from Medicare Advantage exits.","volume":"10","author":"Duggan","year":"2018","journal-title":"Am Econ J Econ Policy"},{"issue":"10","key":"zoi241571r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.3451","article-title":"Comparison of health care utilization by Medicare Advantage and traditional Medicare beneficiaries with complex care needs.","volume":"3","author":"Drzayich Antol","year":"2022","journal-title":"JAMA Health Forum"},{"issue":"12","key":"zoi241571r9","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.46064","article-title":"Comparison of care quality metrics in 2-sided risk Medicare Advantage vs fee-for-service Medicare programs.","volume":"5","author":"Cohen","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi241571r10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.2916","article-title":"Analysis of value-based payment and acute care use among Medicare Advantage beneficiaries.","volume":"5","author":"Gondi","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi241571r15","first-page":"e41","article-title":"Value-based contracting innovated Medicare Advantage healthcare delivery and improved survival.","volume":"23","author":"Mandal","year":"2017","journal-title":"Am J Manag Care"},{"key":"zoi241571r1","unstructured":"Neuman? 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