Accounting for accountable care: Value-based population health management

Abstract

Accountable Care Organizations (ACOs) are exemplars of so-called value-based care in the US. In this model, healthcare providers bear the financial risk of their patients’ health outcomes: ACOs are rewarded for meeting specific quality and cost-efficiency benchmarks, or penalized if improvements are not demonstrated. While the aim is to make providers more accountable to payers and patients, this is a sea-change in payment and delivery systems, requiring new infrastructures and practices. To manage risk, ACOs employ data-intensive sourcing and big data analytics to identify individuals within their populations and sort them using novel categories, which are then utilized to tailor interventions. The article uses an STS lens to analyze the assemblage involved in the enactment of population health management through practices of data collection, the creation of new metrics and tools for analysis, and novel ways of sorting individuals within populations. The processes and practices of implementing accountability technologies thus produce particular kinds of knowledge and reshape concepts of accountability and care. In the process, account-giving becomes as much a procedural ritual of verification as an accounting for health outcomes.

Data as promise: Reconfiguring Danish public health through personalized medicine

“…My investigation of personalized medicine in Denmark explores this data infrastructure and its current reconfigurations. My approach takes leads from work in science and technology studies (STS) on personalized medicine (Hedgecoe, 2004; Reardon, 2011; Tutton, 2012), big data assemblages (Cool, 2016; Hogle, 2016a, 2019), data-intensive population sciences (Ackerman et al, 2016; Bauer, 2013; Moriera and Palladino, 2011) and critical interrogations of public health (Armstrong, 2017; Bauer, 2014; Dumit, 2012). As a native Dane, most of my work could be seen as a form of ‘ethnography at home’ (Jackson, 1987), and in fact I often find myself serving as both ethnographer and data subject.…”

Datafication and accountability in public health: Introduction to a special issue

“…In this volume we describe different types of technological mediation of data practices from seemingly simple checklists (Pickersgill, 2019) and documentary tools (Cool, 2019), to risk scoring (Amelang and Bauer, 2019; Hoeyer, 2019) and sophisticated algorithms that remain black-boxed to many of their users (Hogle, 2019; Kerr et al, 2019). These mediations are techno-metricized accountabilities.…”

“…In recent years and across many nations, public health has become subject to forms of governance said to be aimed at establishing accountability. It has given rise to what Hogle (2019) in her contribution to this volume regards as assemblages (i.e. ‘arrangements of practices, technologies, and theories that configure action in a sociotechnical space’) of accountability.…”

Aging biomarkers and the measurement of health and risk

“…In the context of personalized medicine and personalized nutrition, concerns also relate to the increasing organization of health care around individualized risk (Green and Vogt 2016;Hogle 2019). While the notions of active or healthy aging come with new possibilities for "disciplining aging," they also involve increasing responsibilization of individuals and potential stigmatization of "passive" lifestyles as a failure to age successfully (Katz 1996;Katz and Marshall 2003;Lassen 2014;Lassen and Jespersen 2017).…”