Presentation (CTI)

OBJECTIVES: Shared savings models, particularly the Medicare Shared Savings Program (MSSP), have been implemented to improve care quality and control costs. However, evidence on their impact in stroke care remains limited. This study aimed to evaluate the effects of shared savings models on clinical outcomes, healthcare utilization, and spending among stroke patients.
METHODS: A systematic review was conducted following PRISMA guidelines. MEDLINE, Embase, Scopus, CINAHL, and PubMed were searched from inception to April 14, 2025. Peer-reviewed quantitative studies evaluating MSSP or related models with a control group were included. Outcomes of interest included mortality, readmissions, healthcare utilization, and spending. Study quality was assessed using the Newcastle-Ottawa Scale.
RESULTS: Eight retrospective studies conducted in the United States were included, most using difference-in-differences designs and Medicare claims data. MSSP participation was associated with reductions in 30-day readmission rates, particularly in later implementation stages, without increasing mortality. Evidence on spending was mixed, with one study reporting annual savings of $775 per patient, while others found no significant differences. MSSP participation was associated with reduced length of stay, increased discharge to home, and more days spent in the community. However, disparities persisted among safety-net hospital populations. Evidence on bundled payment models was limited and showed no significant impact in early evaluations.
CONCLUSIONS: Shared savings models demonstrate potential to improve stroke care quality by reducing readmissions without compromising patient safety. Variability in spending and utilization outcomes likely reflects differences in program maturity and design. Persistent disparities highlight the need for targeted policy interventions. Further research is warranted to assess long-term effects and optimize value-based payment strategies.