{
  "schema_version": 2,
  "generated": "2026-09-06",
  "family_wise": {
    "vermont_best_rank": 2,
    "outcome": "ER_VISITS_PER_1000_BENES",
    "units": 50,
    "position": 5,
    "p": 0.1,
    "interpretation": "Family-wise permutation over three co-primary outcomes: each unit contributes its most extreme within-outcome rank. Unlike a Bonferroni correction it does not assume the outcomes are independent."
  },
  "model": {
    "name": "intercept-shifted synthetic control",
    "treatment_year": 2018,
    "pre_period": [
      2014,
      2015,
      2016,
      2017
    ],
    "post_period": [
      2018,
      2019,
      2020,
      2021,
      2022,
      2023,
      2024
    ],
    "treated_unit": "VT",
    "excluded_donors": [
      "MD"
    ],
    "primary_reporting_rule": "Report both post-RMSPE and post/pre-RMSPE placebo ranks. Do not classify either as a definitive hypothesis test.",
    "multiplicity": "Three co-primary Medicare outcomes; interpret the most extreme rank in the family and avoid outcome-wise threshold claims."
  },
  "outcomes": {
    "TOT_MDCR_STDZD_PYMT_PC": {
      "label": "Total standardized payment per capita ($)",
      "estimand": "Vermont minus an intercept-shifted synthetic comparison; incremental 2018 regime change over an already ACO-exposed baseline",
      "actual": {
        "2014": 7050.65,
        "2015": 7391.22,
        "2016": 7540.94,
        "2017": 7669.66,
        "2018": 7716.87,
        "2019": 7818.83,
        "2020": 7273.65,
        "2021": 8137.22,
        "2022": 8567.43,
        "2023": 9314.45,
        "2024": 9544.33
      },
      "synthetic": {
        "2014": 7048.67,
        "2015": 7386.1,
        "2016": 7522.93,
        "2017": 7694.77,
        "2018": 7973.28,
        "2019": 8207.14,
        "2020": 7739.82,
        "2021": 8612.13,
        "2022": 8754.18,
        "2023": 9373.73,
        "2024": 10169.5
      },
      "gap": {
        "2014": 1.98,
        "2015": 5.12,
        "2016": 18.01,
        "2017": -25.11,
        "2018": -256.41,
        "2019": -388.31,
        "2020": -466.17,
        "2021": -474.91,
        "2022": -186.75,
        "2023": -59.28,
        "2024": -625.17
      },
      "weights": {
        "WY": 0.4298,
        "ME": 0.2827,
        "DC": 0.1674,
        "DE": 0.115,
        "AK": 0.0051
      },
      "mean_post_gap": -351.0,
      "mean_post_gap_pct": -4.04,
      "pre_rmspe": 15.693,
      "post_rmspe": 394.355,
      "post_pre_ratio": 25.129,
      "placebo": {
        "n": 49,
        "post_rmspe": {
          "rank": 16,
          "p": 0.32,
          "bonferroni_three_outcomes": 0.96
        },
        "post_pre_ratio": {
          "rank": 25,
          "p": 0.5,
          "bonferroni_three_outcomes": 1
        },
        "interpretation": "Exact ranks under two defensible discrepancy statistics; neither is treated as a binary significance verdict."
      },
      "preperiod_cross_validation": {
        "leave_one_year_out_gap": {
          "2014": -88.138,
          "2015": 11.755,
          "2016": 62.886,
          "2017": -103.353
        },
        "rmse": 75.072,
        "interpretation": "Four temporal holdouts are an overfit diagnostic, not a sampling-based uncertainty interval."
      },
      "leave_one_contributing_donor_out": {
        "gap_2024_by_omitted_donor": {
          "DC": -610.83,
          "DE": -716.61,
          "ME": -759.42,
          "WY": -503.63
        },
        "range": [
          -759.42,
          -503.63
        ],
        "threshold": "baseline donor weight greater than 0.01"
      },
      "predictor_set_stability": {
        "MA_PRTCPTN_RATE": {
          "mean_post_gap": -321.41,
          "delta_vs_baseline": 29.59,
          "post_rmspe_rank": 14,
          "pre_rmspe": 10.255
        },
        "BENE_AVG_AGE": {
          "mean_post_gap": -372.31,
          "delta_vs_baseline": -21.31,
          "post_rmspe_rank": 10,
          "pre_rmspe": 15.821
        },
        "BENE_DUAL_PCT": {
          "mean_post_gap": -481.79,
          "delta_vs_baseline": -130.79,
          "post_rmspe_rank": 11,
          "pre_rmspe": 12.873
        },
        "BENE_FEML_PCT": {
          "mean_post_gap": -356.01,
          "delta_vs_baseline": -5.01,
          "post_rmspe_rank": 13,
          "pre_rmspe": 16.746
        }
      }
    },
    "IP_CVRD_STAYS_PER_1000_BENES": {
      "label": "Inpatient stays per 1,000",
      "estimand": "Vermont minus an intercept-shifted synthetic comparison; incremental 2018 regime change over an already ACO-exposed baseline",
      "actual": {
        "2014": 210.04,
        "2015": 219.62,
        "2016": 218.82,
        "2017": 220.57,
        "2018": 219.02,
        "2019": 213.84,
        "2020": 177.57,
        "2021": 176.96,
        "2022": 175.67,
        "2023": 180.59,
        "2024": 177.91
      },
      "synthetic": {
        "2014": 215.15,
        "2015": 218.06,
        "2016": 217.11,
        "2017": 218.73,
        "2018": 214.51,
        "2019": 210.0,
        "2020": 171.86,
        "2021": 172.16,
        "2022": 168.79,
        "2023": 175.3,
        "2024": 177.15
      },
      "gap": {
        "2014": -5.11,
        "2015": 1.55,
        "2016": 1.71,
        "2017": 1.84,
        "2018": 4.51,
        "2019": 3.83,
        "2020": 5.7,
        "2021": 4.8,
        "2022": 6.88,
        "2023": 5.28,
        "2024": 0.76
      },
      "weights": {
        "MA": 0.4095,
        "NH": 0.3684,
        "AK": 0.1618,
        "NV": 0.0604
      },
      "mean_post_gap": 4.54,
      "mean_post_gap_pct": 2.46,
      "pre_rmspe": 2.954,
      "post_rmspe": 4.877,
      "post_pre_ratio": 1.651,
      "placebo": {
        "n": 49,
        "post_rmspe": {
          "rank": 31,
          "p": 0.62,
          "bonferroni_three_outcomes": 1
        },
        "post_pre_ratio": {
          "rank": 47,
          "p": 0.94,
          "bonferroni_three_outcomes": 1
        },
        "interpretation": "Exact ranks under two defensible discrepancy statistics; neither is treated as a binary significance verdict."
      },
      "preperiod_cross_validation": {
        "leave_one_year_out_gap": {
          "2014": -7.769,
          "2015": 3.776,
          "2016": 3.713,
          "2017": 2.883
        },
        "rmse": 4.917,
        "interpretation": "Four temporal holdouts are an overfit diagnostic, not a sampling-based uncertainty interval."
      },
      "leave_one_contributing_donor_out": {
        "gap_2024_by_omitted_donor": {
          "AK": 4.07,
          "MA": 5.73,
          "NH": -2.9,
          "NV": 1.14
        },
        "range": [
          -2.9,
          5.73
        ],
        "threshold": "baseline donor weight greater than 0.01"
      },
      "predictor_set_stability": {
        "MA_PRTCPTN_RATE": {
          "mean_post_gap": 2.73,
          "delta_vs_baseline": -1.81,
          "post_rmspe_rank": 43,
          "pre_rmspe": 2.435
        },
        "BENE_AVG_AGE": {
          "mean_post_gap": 4.39,
          "delta_vs_baseline": -0.14,
          "post_rmspe_rank": 35,
          "pre_rmspe": 2.988
        },
        "BENE_DUAL_PCT": {
          "mean_post_gap": 7.81,
          "delta_vs_baseline": 3.27,
          "post_rmspe_rank": 18,
          "pre_rmspe": 2.673
        },
        "BENE_FEML_PCT": {
          "mean_post_gap": 5.58,
          "delta_vs_baseline": 1.04,
          "post_rmspe_rank": 26,
          "pre_rmspe": 2.898
        }
      }
    },
    "ER_VISITS_PER_1000_BENES": {
      "label": "ED visits per 1,000",
      "estimand": "Vermont minus an intercept-shifted synthetic comparison; incremental 2018 regime change over an already ACO-exposed baseline",
      "actual": {
        "2014": 651.6,
        "2015": 675.48,
        "2016": 662.27,
        "2017": 661.76,
        "2018": 670.58,
        "2019": 669.9,
        "2020": 541.77,
        "2021": 585.45,
        "2022": 626.76,
        "2023": 657.2,
        "2024": 671.55
      },
      "synthetic": {
        "2014": 652.65,
        "2015": 673.9,
        "2016": 662.88,
        "2017": 661.68,
        "2018": 647.57,
        "2019": 623.03,
        "2020": 487.46,
        "2021": 506.98,
        "2022": 517.32,
        "2023": 520.54,
        "2024": 522.89
      },
      "gap": {
        "2014": -1.06,
        "2015": 1.59,
        "2016": -0.61,
        "2017": 0.08,
        "2018": 23.01,
        "2019": 46.86,
        "2020": 54.31,
        "2021": 78.47,
        "2022": 109.44,
        "2023": 136.66,
        "2024": 148.66
      },
      "weights": {
        "WY": 0.3836,
        "MS": 0.2499,
        "DC": 0.2205,
        "AK": 0.0882,
        "RI": 0.0578
      },
      "mean_post_gap": 85.34,
      "mean_post_gap_pct": 15.62,
      "pre_rmspe": 1.001,
      "post_rmspe": 96.054,
      "post_pre_ratio": 95.945,
      "placebo": {
        "n": 49,
        "post_rmspe": {
          "rank": 2,
          "p": 0.04,
          "bonferroni_three_outcomes": 0.12
        },
        "post_pre_ratio": {
          "rank": 10,
          "p": 0.2,
          "bonferroni_three_outcomes": 0.6
        },
        "interpretation": "Exact ranks under two defensible discrepancy statistics; neither is treated as a binary significance verdict."
      },
      "preperiod_cross_validation": {
        "leave_one_year_out_gap": {
          "2014": -6.265,
          "2015": 10.996,
          "2016": -1.775,
          "2017": 0.013
        },
        "rmse": 6.39,
        "interpretation": "Four temporal holdouts are an overfit diagnostic, not a sampling-based uncertainty interval."
      },
      "leave_one_contributing_donor_out": {
        "gap_2024_by_omitted_donor": {
          "AK": 152.99,
          "DC": 127.13,
          "MS": 136.67,
          "RI": 161.98,
          "WY": 138.57
        },
        "range": [
          127.13,
          161.98
        ],
        "threshold": "baseline donor weight greater than 0.01"
      },
      "predictor_set_stability": {
        "MA_PRTCPTN_RATE": {
          "mean_post_gap": 72.8,
          "delta_vs_baseline": -12.54,
          "post_rmspe_rank": 2,
          "pre_rmspe": 0.676
        },
        "BENE_AVG_AGE": {
          "mean_post_gap": 85.8,
          "delta_vs_baseline": 0.45,
          "post_rmspe_rank": 2,
          "pre_rmspe": 0.992
        },
        "BENE_DUAL_PCT": {
          "mean_post_gap": 80.56,
          "delta_vs_baseline": -4.79,
          "post_rmspe_rank": 2,
          "pre_rmspe": 0.871
        },
        "BENE_FEML_PCT": {
          "mean_post_gap": 91.85,
          "delta_vs_baseline": 6.5,
          "post_rmspe_rank": 2,
          "pre_rmspe": 0.61
        }
      }
    }
  },
  "limitations": [
    "Four pre-treatment years and one treated state.",
    "Treatment date is a regime change after substantial prior ACO exposure.",
    "Most post-treatment years overlap COVID-era disruption.",
    "Fee-for-service composition changes as Medicare Advantage grows.",
    "Statewide Medicare results do not identify Medicaid effects."
  ]
}