Factors That Distinguish High‐Performing Accountable Care Organizations in the Medicare Shared Savings Program

D’Aunno, Thomas; Broffman, Lauren; Sparer, J.D. Michael; Kumar, Manish

doi:10.1111/1475-6773.12642

Cited by 47 publications

(56 citation statements)

References 15 publications

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“…2223 Common changes include improving access to appointments, developing team based models of primary care, coordinating services between care settings, and using data to support care redesign. These changes will feel familiar to many in the NHS.…”

Section: How Are Acos Redesigning Care?mentioning

confidence: 99%

“…Broader evidence also suggests that organisational type is not associated with ACO outcomes 21. Internal organisational factors more to do with leadership, culture, and management—such as capabilities to redesign services or the ability to overcome professional inertia—offer alternative explanations for ACO performance 1323…”

Section: Lessons For the English Nhsmentioning

confidence: 99%

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Can accountable care organisations really improve the English NHS? Lessons from the United States

Alderwick

Shortell

Briggs

2018

BMJ

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Section: How Are Acos Redesigning Care?mentioning

confidence: 99%

Section: Lessons For the English Nhsmentioning

confidence: 99%

Can accountable care organisations really improve the English NHS? Lessons from the United States

Alderwick

Shortell

Briggs

2018

BMJ

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“…11 EHRs are an important means of managing and co-ordinating patient care for effective ACO performance; substance abuse treatment services' use of EHRs predicted how likely they were to participate in an ACO. 57 Other studies corroborate this pattern 63 (see also Chapter 6).…”

Section: Chaptermentioning

confidence: 70%

“…A study of six ACOs found that timely, consistent information about patients' admissions and discharge enabled the planning of follow-up services that patients might need within 30 days of discharge. 63 Two additional studies described individual projects that effectively used HIT to co-ordinate care in MCP-like contexts. The Gesundes Kinzigtal project reported improved patient and health-worker experience, and reduced costs and mortality.…”

mentioning

confidence: 99%

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

Sheaff

Brand

Lloyd

et al. 2018

Health Serv Deliv Res

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Background The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs. Limitations The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed. Conclusions Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience. Study registration This study is registered as PROSPERO CRD42016038900. Funding The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

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“…Since the beginning of the program, the number of ACOs operating in rural America has increased considerably . As CMS releases ACO performance data, it is critical to evaluate how rural ACOs’ performance compares to that of urban ACOs and what organizational attributes are associated with ACO performance to inform policy and practice . This paper contributes such knowledge by evaluating associations between geographic, structural, and service‐provision attributes of MSSP ACOs and the ACOs’ quality performance.…”

mentioning

confidence: 99%

Organizational Attributes Associated With Medicare ACO Quality Performance

Zhu

Mueller

Huang

et al. 2018

The Journal of Rural Health

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Factors That Distinguish High‐Performing Accountable Care Organizations in the Medicare Shared Savings Program

Cited by 47 publications

References 15 publications

Can accountable care organisations really improve the English NHS? Lessons from the United States

Can accountable care organisations really improve the English NHS? Lessons from the United States

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

Organizational Attributes Associated With Medicare ACO Quality Performance

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