The Relationship Between Governing Board Composition and Medicare Shared Savings Program Accountable Care Organizations Outcomes: an Observational Study

Abstract

BACKGROUND: Early studies of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) suggested that physician leadership was an important driver of ACO success, but it is unknown whether the demographic and professional composition of current MSSP ACO governing boards is associated with ACOs' publicly reported outcomes. OBJECTIVE: To investigate whether governing boards with higher physician participation and greater female involvement have better outcomes. DESIGN: Cross-sectional observational study. PARTICIPANTS: All 2017 MSSP ACOs identified by the Center for Medicare and Medicaid Services ACO Public Use Files (PUF). MAIN MEASURES: We collected governing board composition from ACO websites in 2019. Outcome metrics included risk-standardized readmission and unplanned admissions rates. We used descriptive statistics and linear regression models to examine the association between board composition and outcomes. KEY RESULTS: Of the 339 ACOs that still existed in 2019 and had available data, 77% had physicianmajority boards and 11.5% had no women on their boards. Eighty-nine percent reported a Medicare beneficiary on their board, of which about one-third had a woman representative. The average number of members on MSSP ACO boards was 12, with a mean of 67% physicians and 24% women. Board composition varied minimally by ACO characteristics, such as geographic region, number of beneficiaries, or type of participants. Higher levels of physician participation in ACO governing boards were associated with lower all-cause unplanned admission rates for patients with heart failure (p = − 0.26, p < 0.001) and for patients with multiple chronic conditions (p = − 0.28, p = 0.001). The number of women on the board was not associated with any outcome differences.CONCLUSIONS: MSSP ACO governing boards were predominately male and physician-led. Physician involvement may be important for achieving quality goals, while lack of female involvement showcases an opportunity to diversify boards.

Unravelling collaborative governance dynamics within healthcare networks: a scoping review

“…In addition, our scoping review showed that the formation of HN was also influenced by the failure of pre-existing traditional structures to address complex inter-organizational coordination [e.g. mental and social care networks in Belgium and the UK ( Nicaise et al ., 2013 ; Larsen et al ., 2021 )], the unsatisfactory performance of traditional healthcare systems, the inefficiency of informal referral systems, the fragmentation of care, limited connectedness between health providers ( Nicaise et al ., 2013 ) and lack of mutualization of resources ( Palumbo et al ., 2017 ; Reimold et al ., 2022 ).…”

“…In this context, the role of legal policy frameworks was considered a critical contextual factor that laid the foundation for inter-organizational collaborations within HN in high-income ( Audet and Roy, 2016 ; Schneider et al ., 2019 ; Larsen et al ., 2021 ; Reimold et al ., 2022 ) and low-income (e.g. Zambia, South Africa, India) ( Schneider et al ., 2019 ) countries.…”

“…Our scoping review showed that the implementation of shared internal rules of procedures facilitated inter-organizational shared communication channels ( Audet and Roy, 2016 ; de Regge et al ., 2019 ), reduced hospital readmission rates, congestion in tertiary hospitals ( Sequeira D’mello et al ., 2020 ) and unplanned hospital admissions for patients with multiple chronic conditions ( Reimold et al ., 2022 ), and in some cases had positive effects on community knowledge and well-being ( Schneider et al ., 2019 ).…”