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  • 40 minutes de présentation par les auteurs
  • 25 minutes de discussion par un chercheur senior
  • 25 minutes de discussion avec la salle

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 SÉMINAIRE DE RECHERCHE 

Integration and alternatives to pure fee-for-service payment - A mixed-method design with qualitative, cluster and explanatory analysis on Accountable Care Organizations

Mousquès J. (Irdes), Colla C. (The Dartmouth Institute for Health Care Policy and Clinical Practice)
Discussant: Forest P.-G. (School of Public Policy, University of Calgary-Canada)


Rationale: Achieving health care delivery efficiency gains to support the maintenance or expansion of health care coverage is a key aim of the post-Affordable Care Act (ACA) era in the United States. Toward this aim, numerous policies have been implemented to strengthen primary health care delivery, improve coordination and integration with other levels of care, and introduce payment mechanisms to improve quality of care and foster coordination. These efforts include development of the Accountable Care Organization (ACO) model, a payment and delivery system reform experiment using pay-for-performance and risk-sharing mechanisms intended to improve integration and coordination between networks of primary and secondary providers held responsible for the total quality and cost of care for a defined population. Currently, there is a lack of research evaluating the impact of ACOs on performance with consideration of regional and local contexts, organizational characteristics, level of financial risk bearing, and patient characteristics.

Objective: This research aims to analyze ACO integration in combination with ACO pay-for-performance and risk-sharing mechanisms on the efficiency of health care delivery through the measurement of health outcomes, utilization of care by beneficiaries and quality of care delivered. The research hypothesis is that integration associated with mixed payment systems is effective but also that results depend on the context, degree, breadth and nature of integration, and on patient characteristics.

Methods: The analytical and empirical framework is based on a mixed-method design that combines three main sequential and embedded steps. First, qualitative interviews of executives in 16 high-performing ACOs is used to identify a framework of key dimensions of integration. Second, a quantitative exploratory framework, with factor and cluster analysis of mixed data based on waves one to three of the National Survey of ACOs (NSACO) merged with Medicare claims is used to determine ACO characteristics, commonalities and differences. Third, a quantitative explanatory design with econometric analysis is used to estimate if different clusters of ACOs identified in the previous step have a differential impact on efficiency outcomes.

Data sources: Waves one to three of the NSACO were collected by The Dartmouth Institute for Health Policy and Clinical Practice and The School of Public Health at the University of Berkeley. 398 ACOs completed the full survey and 248 were merged with Medicare claims data to obtain information on beneficiaries.

Results: ACO context, integration, and characteristics of patient populations influence the impact of ACOs on efficiency outcomes. ACOs with complete integration are more efficient in terms of quality of care and health care utilization, but less efficient in terms of activity or productivity.

INFOS PRATIQUES

Date

Jeudi 10 novembre 2016

Horaire

11h00

Lieu

Irdes
117bis rue Manin
75019 Paris
France

Plan d'accès

INSCRIPTION