Perceived Benefits & Barriers in Accountable Care Organizations: A Survey of Healthcare Managers

1. Perceived Benefits & Barriers in Accountable Care Organizations:A Survey of Healthcare Managers Thomas T.H. Wan, Ph.D., MHS Maysoun Masri Dimachkie, Ph.D., MPH Judith Ortiz, Ph.D., MBA Blossom Yen Ju Lin, Ph.D. Jeffrey Harrison, Ph.D., MHA October 29, 2012

2. Outlines • Health Care Reform • Benefits & Barriers in ACO Participation • Research Questions • Research Design • Propensity Score Matching & Analysis • Measurements • Path Analysis • Major Findings • Implications and Conclusions October 29, 2012

3. I. Health Care Reform Is Health Care Reform Needed? October 29, 2012

4. Principles of Accountable Health ActMarch 23, 2010 1) Ensure that all Americans have access to quality, affordable health care. 2) Create a new, regulated marketplace where consumers can purchase affordable health care. 3) Extend much needed relief to small business. 4) Improve Medicare by helping seniors and people with disabilities afford their prescription drugs. 5) Prohibit denials of coverage based on pre-existing conditions. 6) Limit out-of-pocket costs so that Americans have security and peace of mind. 7) Help young adults by requiring insurers to allowable dependents to remain on their parents’ plan until age 26. 8) Expand Medicaid to millions of low-income Americans. 9) Provide sliding –scale subsidies to make insurance premiums affordable. 10) Hold insurance companies accountable for how our health care dollars are spent. 11) Clamp down on insurance company abuses. 12) Invest in preventive care. October 29, 2012

5. Ineffective Coordination & Fragmented Care Focus on total cost Focus on unit cost Patient Centric Care October 29, 2012

6. Accountable Care Organization • Establishes partnerships among health care providers to coordinate and deliver efficient care • Assumes joint accountability for improving quality and slowing cost growth • Emphasizes patient-centered care to achieve optimal population health • Adopt innovative delivery systems October 29, 2012

7. II. Perceived Benefits and Barriers of ACOs: Gaps • Benefits • Barriers October 29, 2012

8. III. Research Questions • How do we apply propensity score matching and analysis in health care innovation and diffusion research? • Does the benefit-barrier gap influence the plan for developing a strategic initiative in ACOs (Plan_ACOs) and the willingness to participate in ACOs (WP_ACOs)? • What are the personal, organizational and contextual factors influencing the Plan_ACOs and WP_ACOs? October 29, 2012

9. IV. Research Design • Conventional PSM&A Approach: • Latent Variable Approach October 29, 2012

10. Measurements October 29, 2012

11. V. Major Findings ANOVA of Mean WP_ACOs by Specific Benefits or Barriers October 29, 2012

12. Predictors of Plan_ACOs and WP_ACOs October 29, 2012

13. . October 29, 2012

14. Goodness of fit Statistics for the Predictive Model 1) Chi-square= 30.870 with 27 degrees of freedom and P=0.277; 2) GFI = 0.930, AGFI =0. 858, and CFI = 0.951; and 3) RMESEA = 0.042. October 29, 2012

15. VI. Implications & Conclusions • Benefit-barrier gap directly influences Plan_ACOs, but it indirectly influences WP_ACOs via Plan_ACOs. • Three major hurdles for ACOs: • Lack of leadership support or commitment • Inadequate financial incentives • Legal and regulatory barriers • Personal and organizational factors are more influential than contextual factors in predicting Plan_ACOs and WP_ACOs. • Limitations of the study: Response rate, sampling, and longitudinal study design. • Future research: PSM&A could be useful for evaluating the impact of ACO participation (see next diagram). October 29, 2012

16. ACO PARTICIPATION:A Latent Variable Approach October 29, 2012