# Identifying effective strategies used by Medicare Accountable Care Organizations to improve outcomes for patients with heart failure: A mixed-methods study

> **NIH NIH R01** · NORTHWESTERN UNIVERSITY · 2021 · $615,489

## Abstract

PROJECT SUMMARY
 More than 5.7 million American adults experience heart failure (HF), and prevalence is expected to increase
by 46% in the next two decades. Total costs of HF care exceed $30 billion annually. Patients with HF are at
high risk for poor outcomes, including hospitalization, disability, and death. A novel intervention for lowering
costs and improving quality of care for Medicare beneficiaries is the implementation of Accountable Care
Organizations (ACOs). ACOs consist of groups of doctors and other health care entities that come together
voluntarily to provide their patients with coordinated, high-quality care. If this results in lower costs, the ACO
shares the savings with the Medicare program. ACOs are simultaneously required to meet quality metrics to
ensure that cost reductions are the result of improvements in population health (and not the result of denying
services to beneficiaries). As of 2017, the Medicare Shared Savings Program (MSSP), a large Medicare
program that provides incentives for ACO formation, included more than 9 million Medicare patients across
more than 400 ACOs nationwide. Preliminary data suggests there is variation across ACOs in outcomes for
patients with HF. We hypothesize that this variation is related to differences in the organization and delivery of
care within ACOs. For example, use or implementation of care management may vary across ACOs, leading to
differences in outcomes.
 Our long-term goal is to identify effective delivery-system interventions that improve the health and
outcomes of patients with HF. The objective of this proposal is to identify the strategies and contextual factors
that lead some ACOs to achieve better risk-standardized outcomes including: lower acute admission rates
(RSAARs), fewer days in skilled nursing care (RSSNFs), and lower mortality rates (RSMRs). Aim 1 will
examine outcomes across ACOs and identify patterns in the trajectories of outcomes over time. Each ACO will
be assigned a “phenotype” based on trends in risk-standardized outcomes. We will then examine the
association between phenotypes with ACO characteristics. In Aim 2, we will conduct qualitative interviews with
a sample of ACOs taken from high- and low- performing phenotypes with the goal of refining our understanding
of the factors and strategies that allow some ACOs to achieve better outcomes. For Aim 3, we will conduct a
survey of all remaining MSSP ACOs (those not sampled in Aim 2) to examine associations between identified
strategies and outcomes using multinomial regression. The results of this work will inform health system
leaders and policymakers as they implement care management strategies within ACOs and consider changes
to the MSSP more broadly. These activities are highly responsive to the National Heart Lung and Blood
Institute’s Strategic Goals and Objectives, specifically objective 6, which aims to “optimize translational,
clinical, and implementation research to improve health and reduce disease...

## Key facts

- **NIH application ID:** 10327259
- **Project number:** 7R01HL139985-04
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Tara C Lagu
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $615,489
- **Award type:** 7
- **Project period:** 2018-07-15 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10327259

## Citation

> US National Institutes of Health, RePORTER application 10327259, Identifying effective strategies used by Medicare Accountable Care Organizations to improve outcomes for patients with heart failure: A mixed-methods study (7R01HL139985-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10327259. Licensed CC0.

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