Control Versus Administrative Discretion in Negotiating Voluntary P4P Networks: The Case of Medicaid Accountable Care Organizations

Thompson, Frank J.; Cantor, Joel C.; Houston, Rob

doi:10.1177/0095399718775320

Cited by 3 publications

(3 citation statements)

References 38 publications

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“…To meet the unique needs of the Medicaid population and increase provider participation, states allowed significant flexibility on several dimensions. First, most states gave ACOs latitude when deciding the composition of providers eligible to become ACOs, consistent with findings of a prior study . Second, recognizing that ACOs include different networks of providers and that one ACO's attributed population will not look like another, states offered ACOs flexibility in operational requirements.…”

Section: Resultssupporting

confidence: 68%

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

et al. 2019

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Maine, Massachusetts, Minnesota, and Vermont leveraged State Innovation Model awards to implement Medicaid accountable care organizations (ACOs). Flexibility in model design, ability to build on existing reforms, provision of technical assistance to providers, and access to feedback data all facilitated ACO development. Challenges included sustainability of transformation efforts and the integration of health care and social service providers. Early estimates showed promising improvements in hospital‐related utilization and Vermont was able to reduce or slow the growth of Medicaid costs. These states are sustaining Medicaid ACOs owing in part to provider support and early successes in generating shared savings. The states are modifying their ACOs to include greater accountability and financial risk. Context As state Medicaid programs consider alternative payment models (APMs), many are choosing accountable care organizations (ACOs) as a way to improve health outcomes, coordinate care, and reduce expenditures. Four states (Maine, Massachusetts, Minnesota, and Vermont) leveraged State Innovation Model awards to create or expand Medicaid ACOs. Methods We used a mixed‐methods design to assess achievements and challenges with ACO implementation and the impact of Medicaid ACOs on health care utilization, quality, and expenditures in three states. We integrated findings from key informant interviews, focus groups, document review, and difference‐in‐difference analyses using data from Medicaid claims and an all‐payer claims database. Findings States built their Medicaid ACOs on existing health care reforms and infrastructure. Facilitators of implementation included allowing flexibility in design and implementation, targeting technical assistance, and making clinical, cost, and use data readily available to providers. Barriers included provider concerns about their ability to influence patient behavior, sustainability of provider practice transformation efforts when shared savings are reinvested into the health system and not shared with participating clinicians, and limited integration between health care and social service providers. Medicaid ACOs were associated with some improvements in use, quality, and expenditures, including statistically significant reductions in emergency department visits. Only Vermont's ACO demonstrated slower growth in total Medicaid expenditures. Conclusions Four states demonstrated that adoption of ACOs for Medicaid beneficiaries was both possible and, for three states, associated with some improvements in care. States revised these models over time to address stakeholder concerns, increase provider participation, and enable some providers to accept financial risk for Medicaid patients. Lessons learned from these early efforts can inform the design and implementation of APMs in other Medicaid programs.

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Section: Resultssupporting

confidence: 68%

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

et al. 2019

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“…ACOs are responsible for all Medicaid beneficiaries in a defined geographic region and contract with all hospitals, 75% of the primary care physicians, and at least four behavioral health providers in that region. Thirteen low-income areas of New Jersey were identified as possible ACO regions, and three ultimately were approved: Trenton, Camden, and Newark (Thompson & Cantor, 2016). Each ACO is required to have a strategy to improve outcomes related to the quality and efficiency of health care, patient safety, and patient satisfaction.…”

Section: Conceptual Framework and Methodsmentioning

confidence: 99%

Medicaid Accountable Care Organizations and Childbirth Outcomes

et al. 2019

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Some states have adopted Accountable Care Organization (ACO) models to transform their Medicaid programs, but little is known about their impact on health care outcomes and costs. Medicaid ACOs are uniquely positioned to improve childbirth outcomes because of the number of births covered by Medicaid. Using Healthcare Cost and Utilization Project hospital data, we examined the relationship between ACO adoption and (a) neonatal and maternal outcomes, and (b) cost per birth. We compared outcomes in states that have adopted ACO models in their Medicaid programs with adjacent states without ACO models. Implementation of Medicaid ACOs was associated with a moderate reduction in hospital costs per birth and decreased cesarean section rates. Results varied by state. We found no association between Medicaid ACOs and several birth outcomes, including infant inpatient mortality, low birthweight, neonatal intensive care unit utilization, and severe maternal morbidity. Improving these outcomes may require more time or targeted interventions.

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“…Shared commitment reinforces synergy among partners who develop a strong sense of ownership and long-term alliance during all project phases ( Larsen et al ., 2021 ). Scholars highlighted the importance of maintaining a trustworthy climate and internal legitimacy, which facilitates the adoption of quality improvement healthcare initiatives ( Bretas and Shimizu, 2017 ; Thompson et al ., 2020 ) and fosters long-term sustainable inter-organizational collaboration ( Karlsson et al ., 2020 ).…”

Section: Resultsmentioning

confidence: 99%

Unravelling collaborative governance dynamics within healthcare networks: a scoping review

Belrhiti,

Bigdeli,

Lakhal

et al. 2024

Health Policy and Planning

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In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalised healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges, and enablers for effective inter-organisational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organisational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews (Arksey and O Malley, 2005), we searched four databases (PubMed (n=114), Web of Science (n=171), Google Scholar (n=153), and Scopus (n=52) and snowballing (n=22)). Thirty-seven papers addressing HN including hospitals were included. We used a framework synthesis informed by the (Emerson, 2011) collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g., strategic versus steering committees), formal procedural arrangements, and strategic governing bodies in stimulating participative decision-making, collaboration, and sense of ownership. In a highly institutionalised context, the inter-organisational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualising resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems. To promote effectiveness of HN, more bottom-up participative decision-making, formalisation of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.

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Control Versus Administrative Discretion in Negotiating Voluntary P4P Networks: The Case of Medicaid Accountable Care Organizations

Cited by 3 publications

References 38 publications

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

Medicaid Accountable Care Organizations and Childbirth Outcomes

Unravelling collaborative governance dynamics within healthcare networks: a scoping review

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