{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T08:00:10Z","timestamp":1780646410156,"version":"3.54.1"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AG068074"],"award-info":[{"award-number":["R01 AG068074"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between implementation of \u201cPathways to Success\u201d and quality among beneficiaries cared for in Shared Savings Program accountable care organizations (ACOs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>Medicare initiated \u201cPathways to Success\u201d in 2019 that required upside\u2010risk only ACOs in Shared Savings Program to transition to a two\u2010sided risk model and prior two\u2010sided ACOs to assume even greater financial responsibility. We examined the association between Pathways and ACO\u2010targeted (hospitalizations for congestive heart failure [CHF] and all\u2010cause 30\u2010day readmissions) and nontargeted (all\u2010cause emergency department visits without hospitalization for CHF and hospital observation stays) quality measures, using a difference\u2010in\u2010differences framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>Data were extracted from a 20% sample of national Medicare data from 2018 to 2020. This study included 810,070 beneficiary\u2010quarters in 514 ACOs, and 813,855 beneficiary\u2010quarters never attributed to an ACO (i.e., controls).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Implementation of Pathways was not associated with significant relative changes in the quarterly number of CHF admissions (decreasing from 97.98 to 82.04 per 1000 beneficiaries in ACOs; differential change\u2009=\u20093.51 quarterly CHF admissions per 1000 beneficiaries, 95% CI, \u22124.82 to 11.85) or the quarterly number of emergency department visits for CHF (decreasing from 110.90 to 97.50 per 1000 beneficiaries in ACOs; differential change\u2009=\u20096.47 quarterly CHF emergency department visits per 1000 beneficiaries, 95% CI, \u22123.71 to 16.64). However, quarterly rates of 30\u2010day all\u2010cause readmissions increased slightly by 0.61% points (95% CI, 0.23 to 0.98; unadjusted readmissions increased from 14.49% to 14.81% in ACOs) after Pathways implementation. Observation stays remained unchanged (differential change\u2009=\u2009\u22120.16% points, 95% CI, \u22120.33 to 0.02; unadjusted observation stays increased from 3.64% to 3.94% in ACOs) after the launch of Pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medicare's Pathways to Success, which introduced two\u2010sided risk, was not associated with improvement in select quality measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70024","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T06:50:10Z","timestamp":1754031010000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Pathways to Success Launch With Quality inBeneficiaries With Traditional Medicare"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3012-9791","authenticated-orcid":false,"given":"Meiling","family":"Ying","sequence":"first","affiliation":[{"name":"Department of Foundations of Medicine NYU Langone Health  Mineola New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Addison","family":"Shay","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Hirth","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Hollingsworth","sequence":"additional","affiliation":[{"name":"Department of Urology University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahakn B.","family":"Shahinian","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent K.","family":"Hollenbeck","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Centers for Medicare and Medicaid Services Program Data.2023.https:\/\/www.cms.gov\/medicare\/medicare\u2010fee\u2010for\u2010service\u2010payment\/sharedsavingsprogram\/program\u2010data."},{"key":"e_1_2_10_3_1","article-title":"Medicare Accountable Care Organization Results for 2016: Seeing Improvement, Transformation Takes Time","author":"Saunders R.","year":"2017","journal-title":"Health Affairs Blog"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.8087"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.4585"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1600142"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100009.12468"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1803388"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.4449"},{"key":"e_1_2_10_10_1","unstructured":"Centers for Medicare and Medicaid Servcies Final Rule Creates Pathways to Success for the Medicare Shared Savings Program.2022.https:\/\/www.cms.gov\/newsroom\/fact\u2010sheets\/final\u2010rule\u2010creates\u2010pathways\u2010success\u2010medicare\u2010shared\u2010savings\u2010program."},{"key":"e_1_2_10_11_1","first-page":"e1","article-title":"ACO Quality Over Time: The MSSP Experience and Opportunities for System\u2010Wide Improvement","volume":"6","author":"Pham H. 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