Evaluating the Impact of an Accountable Care Organization on Population Health: The Quasi-Experimental Design of the German Gesundes Kinzigtal

Abstract

Phone: +49 40 22621149-0 page 4 Conflict of interestMr. Schulte, Dr. Groene and Mr. Hildebrandt are employees of the OptiMedis AG. Dr. Pimperl was also employed by the OptiMedis AG, but is currently a Harkness Fellow in Health Care Policy and Practice and does not receive any funding from the OptiMedis AG. The OptiMedis AG is the management partner and shareholder of the Gesundes Kinzigtal GmbH, which is used as study setting for the empirical application of the evaluation design described in this paper. Mr. Hildebrandt is also the CEO of the Gesundes Kinzigtal GmbH. There are no conflicts of interest for the other co-authors. FundingAt the time this manuscript was developed, Dr. Pimperl was engaged in the Harkness Fellowship in Health Care Policy and Practice, supported by The Commonwealth Fund, a private independent foundation based in New York City. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund, its directors, officers, or staff.page 5 Abstract:A central goal of accountable care organizations (ACOs) is to improve the health of their accountable population. No evidence currently links ACO development to improved population health. A major challenge to establishing the evidence-base for the impact of ACOs on population health is the absence of a theoretically-grounded, robust, operationally feasible, and meaningful research design. We present an evaluation study design, provide an empirical example, and discuss considerations for generating the evidence-base for ACO implementation.A quasi-experimental study design using propensity score matching in combination with smallscale exact-matching is implemented. Outcome indicators based on claims data were constructed and analyzed. Population health is measured by using a range of mortality indicators: mortality ratio, age at the time of death, years of potential life lost / gained and survival time. The application is assessed using longitudinal data from Gesundes Kinzigtal, one of the leading population-based ACOs in Germany.The proposed matching approach resulted in a balanced control of observable differences between the intervention (ACO) and control group. The mortality indicators used, indicate positive results. For example, 635.6 fewer years of potential life lost (2,005.8 vs. 2,641.4; T-Test: sig. p<0.05*) in the ACO-intervention group (n=5,411), attributable to the ACO, also after controlling for a potential (indirect) immortal time bias by excluding the first half year after enrollment from the outcome measurement.Our empirical example of the impact of a German ACO on population health can be extended to the evaluation of ACOs and other integrated delivery models of care.

Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review

“…as dyadic relationships between two partner organisations or as inter-organisational networks, implying relationships between at least three partners [24]. The variety of such collaborations in healthcare includes, among others, healthcare alliances [28], urban healthcare-delivery networks [15], digital health platforms that rely on interorganisational collaboration [29], and regional networks of service providers that negotiate population-based care contracts [16]. They can take on – following the integration needs of care – several directions: vertical collaboration along the chain of health service delivery, including, for instance, collaboration between providers of primary and secondary care, or horizontal collaboration between organisations of the same kind, e.g.…”

“…For instance, in the U.S., community-based health and human services are often delivered by networks of independent providers [15]. Additionally, accountable care organisations which can be found in the U.S., but also in countries like Germany, involve inter-organisational collaboration [1617]. The British NHS has experimented with the integration of care through inter-organisational collaboration since the 1990s [8], as have the Nordic countries [18] and the Netherlands [8].…”

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…Its models of care are based on the collaboration (still unusual in Germany) of doctors, hospitals, social care, nursing staff, therapists and pharmacies. The project offers 'a set of community initiatives', 19 preventative, patient self-management and health promotion activities. 20 It has been described 19 as an accountable care organisation (ACO).…”

“…The project offers 'a set of community initiatives', 19 preventative, patient self-management and health promotion activities. 20 It has been described 19 as an accountable care organisation (ACO). It provides individual treatment plans, post-discharge follow-up care and case management.…”

Competing and conflicting interests in the care of critically ill patients

“…Similarly, the organization of some novel healthcare financing systems in Europe intends to strengthen patient-specific decision-making. [16] When secondary competing interests cannot be eliminated, the risk that they will influence a physician’s judgement should be minimized via procedures that allow decisions to be periodically reviewed for evidence of undue influence. Conflicts of interest are ubiquitous throughout medicine, but the potential consequences for critically ill patients who generally lack the ability to advocate for themselves or seek care elsewhere, makes it important to explicitly address this issue in the ICU setting.…”