{"doi":"10.1111/1475-6773.70024","title":"Association of Pathways to Success Launch With Quality inBeneficiaries With Traditional Medicare","abstract":"OBJECTIVE: To evaluate the association between implementation of \"Pathways to Success\" and quality among beneficiaries cared for in Shared Savings Program accountable care organizations (ACOs). STUDY SETTING AND DESIGN: 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 SOURCES AND ANALYTIC SAMPLE: 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). PRINCIPAL FINDINGS: 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. CONCLUSIONS: Medicare's Pathways to Success, which introduced two-sided risk, was not associated with improvement in select quality measures.","journal":"Health Services Research","year":2025,"id":571488,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9516,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":918194,"name":"Addison Shay","orcid":"0000-0003-1651-317X","position":1,"is_corresponding":false},{"id":470275,"name":"Richard A. Hirth","orcid":"0000-0002-0654-3220","position":2,"is_corresponding":false},{"id":413784,"name":"John M. Hollingsworth","orcid":"0000-0002-3372-9370","position":3,"is_corresponding":false},{"id":265841,"name":"Vahakn B. Shahinian","orcid":"0000-0003-3280-7821","position":4,"is_corresponding":false},{"id":578341,"name":"Brent K. Hollenbeck","orcid":"0000-0003-4840-1260","position":5,"is_corresponding":false},{"id":471409,"name":"Meiling Ying","orcid":"0000-0002-3012-9791","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T02:57:15.755535Z","pmid":"40746042","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}