Changes in Health Care Utilization and Low-Value Service Use After Risk-Based Contract Adoption in Medicare Advantage

Is voluntary transition by health care organizations to risk-based payment contracts (either upside-only contracts with financial bonuses possible or 2-sided contracts with both bonuses and penalties possible) associated with differential changes in health care utilization or use of low-value services?This cohort study included health care organizations that transitioned to upside-only contracts (n = 658) or 2-sided risk contracts (n = 114) offered by a large Medicare Advantage insurer, as well as control organizations (n = 3385). For transitioning organizations, contract transition was not consistently associated with differential changes in utilization or low-value service use relative to organizations that did not change contract type.Voluntary transition to risk-based payment contracts in Medicare Advantage may not be associated with changes in utilization or reductions in low-value service use.

Corresponding Author: Aaron L. Schwartz, MD, PhD, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104 (aaron.schwartz@pennmedicine.upenn.edu).

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