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ObjectiveTo examine the extent to which accountable care organizations (ACOs) formally incorporate postacute care providers.Data sourcesThe National Survey of ACOs (N = 269, response rate 66 percent).Study designWe report statistics on ACOs' formal inclusion of postacute care providers and the organizational characteristics and clinical capabilities of ACOs that have postacute care.Principal findingsHalf of ACOs formally include at least one postacute service, with inclusion at higher rates in ACOs with commercial (64 percent) and Medicaid contracts (70 percent) compared to ACOs with Medicare contracts only (45 percent). ACOs that have a formal relationship with a postacute provider are more likely to have advanced transition management, end of life planning, readmission prevention, and care management capabilities.ConclusionsMany ACOs have not formally engaged postacute care, which may leave room to improve service integration and care management.

Research in oncology quality of care and health outcomes has been limited by the difficulty of identifying cancer stage in health care claims data. Using linked cancer registry and Medicare claims data, we develop a tool for classifying lung cancer patients receiving chemotherapy into early vs. late stage cancer by ( i ) deploying ensemble machine learning for prediction, ( ii ) establishing a set of classification rules for the predicted probabilities, and ( iii ) considering an augmented set of administrative claims data. We find our ensemble machine learning algorithm with a classification rule defined by the median substantially outperforms an existing clinical decision tree for this problem, yielding full sample performance of 93% sensitivity, 92% specificity, and 93% accuracy. This work has the potential for broad applicability as provider organizations, payers, and policy makers seek to measure quality and outcomes of cancer care and improve on risk adjustment methods.