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Scholarly Works (4 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2014)

Objective. To assess the role of health information technology (HIT) in advancing the care management implementation of Accountable Care Organizations (ACOs).

Data sources/study setting. Data from the National Survey of Accountable Care Organizations (NSACO), a web-based survey of ACOs in the United States administered from October 2012 to May 2013, which includes data from 173 ACOs with either public or private payer partners. In addition, semi-structured interviews lasting 45-60 minutes were conducted between December 2012 and February 2013 with 20 leaders of 11 ACOs.

Study design. Retrospective cross-sectional analysis. A measure of ACO care management implementation was created from seven survey questions related to the following care management capabilities: chronic care programs, care transitions programs, and patient engagement activities (Cronbach's alpha = 0.84). HIT capability was measured using nine questions which asked about functionalities such as the extent of the primary ACO organization's inpatient and outpatient data integration, degree of electronic referral information exchange, as well as various electronic health record capabilities. For the qualitative analysis, constant comparative method was used to identify and code comments related to how ACOs were using HIT to capture, provide, and exchange information in general and in the context of care management in particular.

Principal findings. Multivariate regression using multiple imputation to account for missing data showed that HIT was associated with a significant increase in ACO care management implementation, controlling for factors related to the ACO organization, contracts, and financial motivation (0.38, p<0.001 and 0.19, p>0.001 for ACOs with single and multiple contracts, respectively). The relationship was then assessed when HIT functionality was categorized by its coordination role - information capture, provision, and exchange. Information exchange activities were found to be more greatly associated with ACO care management implementation as compared to information capture and provision activities (p<0.001). In addition, in the interviews we saw several examples of information provision, capture, and exchange using health IT in the care management context.

Conclusion. The findings suggest that HIT is significantly and positively associated with the development of ACO care management capabilities. HIT may play an important coordination role given the given the different types of coordination needed in delivering various aspects of patient care. Conceptualization of HIT coordination in ACOs may be useful to increase understanding of the relationship between HIT and care management.

    Cover page: The role of health information technology in early accountable care organizations in the United States
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2014)

    Objective

    To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance.

    Data sources/study setting

    Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs.

    Study design

    Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data.

    Principal findings

    We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital-physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities.

    Conclusions

    ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations.
      Cover page: A Taxonomy of Accountable Care Organizations for Policy and Practice
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2016)

      Background

      The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the cost of care. An ACO's success in meeting these objectives depends greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency.

      Purpose

      The purpose of this paper is twofold: (a) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (b) identify the ways these leaders believe the dimensions influenced care management practices in their organization.

      Methodology/approach

      We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices.

      Findings

      ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions - shared knowledge of team members' tasks, mutual respect, and accuracy of communication - were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning.

      Discussion

      We propose two hypotheses for future research on relational coordination and care management.

      Practice implications

      If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational coordination's influence on care management in their ACO. We suggest a number of means by which ACO leaders could become more aware of relational coordination and its potential effects.
        Cover page: Contributions of relational coordination to care management in accountable care organizations
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2016)

        Objective

        To compare early and later adopters of the accountable care organization (ACO) model, using the taxonomy of larger, integrated system; smaller, physician-led; and hybrid ACOs.

        Data sources

        The National Survey of ACOs, Waves 1 and 2.

        Study design

        Cluster analysis using the two-step clustering approach, validated using discriminant analysis. Wave 2 data analyzed separately to assess differences from Wave 1 and then data pooled across waves.

        Findings

        Compared to early ACOs, later adopter ACOs included a greater breadth of provider group types and a greater proportion self-reported as integrated delivery systems. When data from the two time periods were combined, a three-cluster solution similar to the original cluster solution emerged. Of the 251 ACOs, 31.1 percent were larger, integrated system ACOs; 45.0 percent were smaller physician-led ACOs; and 23.9 percent were hybrid ACOs-compared to 40.1 percent, 34.0 percent, and 25.9 percent from Wave 1 clusters, respectively.

        Conclusions

        While there are some differences between ACOs formed prior to August 2012 and those formed in the following year, the three-cluster taxonomy appears to best describe the types of ACOs in existence as of July 2013. The updated taxonomy can be used by researchers, policy makers, and health care organizations to support evaluation and continued development of ACOs.
          Cover page: Assessing Differences between Early and Later Adopters of Accountable Care Organizations Using Taxonomic Analysis
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