# Association of Pathways to Success Launch With Quality inBeneficiaries With Traditional Medicare

## TL;DR

This study examines whether Medicare's Pathways to Success program improved healthcare quality for beneficiaries in ACOs.

## Contribution

The study evaluates the impact of transitioning ACOs to two-sided risk models on specific quality measures.

## Key findings

- Pathways to Success was not associated with significant changes in CHF hospitalizations or emergency department visits.
- 30-day all-cause readmissions increased slightly after Pathways implementation.
- Observation stays remained largely unchanged following the program's launch.

## Abstract

To evaluate the association between implementation of “Pathways to Success” and quality among beneficiaries cared for in Shared Savings Program accountable care organizations (ACOs).

Medicare initiated “Pathways to Success” in 2019 that required upside‐risk only ACOs in Shared Savings Program to transition to a two‐sided risk model and prior two‐sided ACOs to assume even greater financial responsibility. We examined the association between Pathways and ACO‐targeted (hospitalizations for congestive heart failure [CHF] and all‐cause 30‐day readmissions) and nontargeted (all‐cause emergency department visits without hospitalization for CHF and hospital observation stays) quality measures, using a difference‐in‐differences framework.

Data were extracted from a 20% sample of national Medicare data from 2018 to 2020. This study included 810,070 beneficiary‐quarters in 514 ACOs, and 813,855 beneficiary‐quarters never attributed to an ACO (i.e., controls).

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 = 3.51 quarterly CHF admissions per 1000 beneficiaries, 95% CI, −4.82 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 = 6.47 quarterly CHF emergency department visits per 1000 beneficiaries, 95% CI, −3.71 to 16.64). However, quarterly rates of 30‐day all‐cause 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 = −0.16% points, 95% CI, −0.33 to 0.02; unadjusted observation stays increased from 3.64% to 3.94% in ACOs) after the launch of Pathways.

Medicare's Pathways to Success, which introduced two‐sided risk, was not associated with improvement in select quality measures.