Moving Organizational Culture from Volume to Value: A Qualitative Analysis of Private Sector Accountable Care Organization Development

McAlearney, Ann Scheck; Walker, Daniel M.; Hefner, Jennifer L

doi:10.1111/1475-6773.13012

Cited by 14 publications

(23 citation statements)

References 30 publications

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“…ACOs expand on the concept of a PCCM and PHM through the broader goal of coordinating care for a panel of patients within a defined geographic HSA based on physician stakeholder ACO participation 44,45 . ACOs incentivize the Triple Aim of PHM within an HSA through shared financial risk‐reward APMs combining fee‐for‐service payments with a P4P MCBR payment linked to quality metrics within a Population‐Based Payment (PBP) model 38,43‐48 . Use of APMs to create risk sharing between the payer and the physician stakeholders realigned the traditional relationship in a fee‐for‐service structure which relied on a more hierarchical volume driven transactional payment relationship which, at times, could be adversarial.…”

Section: Discussionmentioning

confidence: 99%

A field guide to U.S. healthcare reform: The evolution to value‐based healthcare

Harrill

Melon²

2021

Laryngoscope Investig Oto

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Objective A consolidated state‐of‐the‐art review of U.S. healthcare reform efforts that documents the evolution towards value‐based healthcare (VBH) is lacking in peer‐review literature. This field guide attempts to clarify working definitions and conceptual boundaries within the lexicon of U.S. healthcare reform efforts that predated and have common thematic perspectives within the evolving VBH reform paradigm. Data Sources Pubmed/MEDLINE/Google search. Review Methods Pubmed/MEDLINE/Google search was performed during August 1, 2020‐January14, 2021 for U.S. healthcare reform terms, legislative and government agency publications. Those citing relevant legislative, regulatory, philosophical and technological advancements integral to the development and function of VBH were catalogued according to the targeted stakeholders and evolving reform strategy or technology. Conclusions Eight healthcare reform paradigms were identified as influential precursors to VBH: Patient‐Centered Care Model, Patient‐Centered Medical Home, Population Health, Personalized Medicine, P4 Medicine, Precision Medicine, Managed Care, and Accountable Care. Several of these models have similar nomenclature and, confusingly, many have multiple interpretations of the terms used to describe these models. However, consistent stakeholders identified within these paradigms are key to VBH; notably the patient, the physician and the payer (the “Big 3”). Demonstrable healthcare spending reductions have been best achieved when the Big 3 stakeholder interests are aligned within healthcare reform legislation. The definition of “Value” within each reform model was found to be based upon the perspective of the targeted stakeholder. Within VBH, the perspectives of the Big 3 stakeholders form a multidimensional meaning of “Value” that can be represented by the equation Value = Patient Experience Management3.

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Section: Discussionmentioning

confidence: 99%

A field guide to U.S. healthcare reform: The evolution to value‐based healthcare

Harrill

Melon²

2021

Laryngoscope Investig Oto

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“…Yet, based on the literature, the interactive relationship between policy and practice is unrecognised, and the role of policymaking in advancing VBHC remains elusive. 7 The evolution towards VBHC is an iterative process in which top-down strategies are combined with bottom-up organisational innovations. 10 Therefore, we suggest adding a third dimension to examinations of the implications of VBHC logics, namely national patient-centred health policies.…”

Section: Value-based Healthcare Logics and Nordic Health Policiesmentioning

confidence: 99%

“…4 Today, VBHC is a widely approved logic for financing services, using innovative care models and evaluating healthcare outcomes. 1,5–7…”

Section: Introductionmentioning

confidence: 99%

“…1 In Nordic countries, recent research has mainly concentrated on the implementation of VBHC as a strategic concept in developing hospitals, new organisational forms or clinical work. 9,10 Moreover, the emphasis in studies on VBHC’s implications has been on organisational culture, the attitudes of professionals 7,14 and the measurement of performance. 15…”

Section: Introductionmentioning

confidence: 99%

“…The importance of examining whether different approaches to health policy can fundamentally alter the paradigm from volume-based- towards value-based care is evident, 1,7,19 but demonstrating the cultural change requires a focus on how national policy agendas support this transition. The critical arguments concerning Porter’s VBHC logic state that ‘VBHC may cause serious infringements upon medical ethical principles’, 11 and these arguments challenge its claimed impact on creating value for patients.…”

Section: Introductionmentioning

confidence: 99%

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Value-based healthcare logics and their implications for Nordic health policies

Kokko

Kork

2020

Health Serv Manage Res

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Value-based healthcare (VBHC) is a widely approved logic for financing services, using innovative care models and evaluating healthcare outcomes. It is consistent with the Triple Aim framework of simultaneously improving population health, patient experience and the costs of care. In Nordic countries, VBHC has been mainly implemented as a strategic concept in developing hospitals. Despite the evident interest in VBHC as a management trend in healthcare organisations, the studies concerning the implications of VBHC logics on health policies have been scant. This study aimed to fill this gap by building a conceptual bridge between national health policy and value-based care. Through the Triple Aim framework, we explored how VBHC goals have evolved in Finnish Government Programmes from 1995 to 2015 by using qualitative document analysis and interviews. The study addresses the evolution and national impacts of VBHC. Our results show that the goals of Triple Aim gradually become evident at the Finnish health policies. All three Triple Aim goals were present, though the equal prioritisation of these goals only emerged in 2015, also highlighting patient experience. We argue that VBHC logics have indeed affected Nordic welfare policies, not only at the organisational level but also concerning performance measurement and care delivery. This may imply that the diffusion of VBHC logics evolves from healthcare organisations to policymaking instead of top-down. Particularly in publicly financed systems, VBHC indicates a transformation to a new public governance ideology, accelerating policy goals that promote customer responsiveness and value creation for citizens.

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Accountable Care at the Frontlines of a Health System

Ferris

2018

JAMA

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In a time of uncertainty about the future of health care in the United States, at least 2 issues are clear. First, the current system is flawed-at times delivering both too much and too little care that is often fragmented, poorly communicated, and expensive. Second, the incentives in still-pervasive fee-for-service payment models are the basis for many of these problems. The current policy antidote, consisting of alternative payment models such as accountable care organizations (ACOs), builds on the failed managed care experiment of the 1990s, again relying on a budget for a defined population of patients but this time with checks on quality, unrestricted patient choice, and attenuated financial risk. 1 Although early studies of the model show only modest success thus far, 2 ACOs now cover more than 32 million individuals in the United States through commercial and public contracts, and the federal government has indicated it will continue to emphasize this approach. 3 For many health systems, the ACO model provides a catalyst for much-desired improvements, 4 both through well-established mechanisms and more experimental approachesthatcannowbeexplored.Strategiessuchascare

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Moving Organizational Culture from Volume to Value: A Qualitative Analysis of Private Sector Accountable Care Organization Development

Abstract: We found that moving from volume to value is central to the culture change required of an ACO. Our findings can inform future efforts that aim to create a more effective value-based health care system.

Cited by 14 publications

References 30 publications

A field guide to U.S. healthcare reform: The evolution to value‐based healthcare

A field guide to U.S. healthcare reform: The evolution to value‐based healthcare

Value-based healthcare logics and their implications for Nordic health policies

Accountable Care at the Frontlines of a Health System

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