Infrastructural mechanisms leading toward pro-accountable care organisation orientation: a survey of hospital managers

Abstract

Organisations across the country are transforming the way they deliver care, in ways similar to the accountable care organisation (ACO) model supported by Medicare. ACOs modalities are varying in size, type, and financing structure. Little is known about how specific infrastructural mechanisms influence hospital managers’ pro-ACO orientation. Using an electronic-survey of hospital managers, this study explores how pro-ACO orientation, as a latent construct, is captured from the perceptions of hospital managers; and identify infrastructural mechanisms leading to the formation of pro-ACO orientation. Of the total hospital respondents, 58% are moving toward the establishment of ACOs; 56% are planning to join in the next two years; 48% are considering joining ACOs; while 25% had already participated in ACOs during 2012. Urban hospitals are more likely than rural hospitals to be engaged in ACO development. The health provider network size is one of the strongest indicators in predicting pro-ACO orientation.

Primary Care Clinics and Accountable Care Organizations

“…Finally, although there is some theoretical basis for relating the number of the health care provider’s network affiliations to a pro-ACO orientation, 7 we were not able to examine this association for the RHC respondents. We had posed a question on the number and nature of the respondent clinic’s network affiliations.…”

“…Indeed, the number of network affiliations has been found to be positively and significantly related to pro-ACO orientation in a recent study of acute care hospitals. 7 Primary care organizations and hospitals located in rural areas may be delayed in joining ACOs or deterred from joining them altogether. Thus far, ACOs are more often located in urban areas.…”

“…3 Urban hospitals have been found to be more likely than rural hospitals to be involved in ACO development. 7 In rural areas, on the other hand, the disparate missions of RHCs, rural Federally Qualified Health Centers, small rural hospitals, and other independent rural ambulatory care practices may impede the collaboration necessary for ACO formation. 8 Furthermore, in sparsely populated rural areas, Medicare ACOs may not be accessible to RHCs because the surrounding area does not have the required minimum patient base of 5000 Medicare beneficiaries.…”

“…Indeed, the number of network affiliations has been found to be positively and significantly related to pro-ACO orientation in a recent study of acute care hospitals. 7…”

Does Patient-Centered Medical Home Recognition Relate to Accountable Care Organization Participation?

“…22,23 Mackinney and colleagues 24 suggested that rural providers should use a network with a larger health care systems strategy to establish ACOs. Wan and colleagues 25 emphasize how organizations with a large health provider network size increase their likelihood of participating in an ACO. However, many RHCs are not familiar with ACOs as a new health care delivery model.…”