UC Berkeley

Improving quality has a been a major focus of the United States healthcare system, which has led to an increase in financing schemes and care models designed to this end. Accountable care organizations (ACOs) are the among the largest of these efforts, providing incentives for providers to join together in assuming responsibility for a set of shared patients. Understanding how providers and the ACOs in which they participate achieve their quality outcomes is difficult given the complexity of the systems in which they operate. This dissertation investigates healthcare quality through several perspectives. The first paper uses a taxonomy of ACOs to explore whether the structural characteristics and prior experiences of these organizations are associated with their performance on publicly available quality and financial measures. In the second paper, practice-level characteristics including self-reported culture and ACO participation are used to explore what factors are associated with practices’ use of decision aids in the context of shared decision-making. The final paper combines the practice and ACO-level variables into a single model to compare the relative contribution of each organizational level to ACO quality.