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A Tale of Two Physician Organization Ownership Types. Margaret C. Wang RAND/UCLA Post-Doctoral Fellow AcademyHealth Annual Research Meeting. Background. The “quality chasm” in health care Paradigm shift in chronic care delivery The crucial role of physician organizations (POs).
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A Tale of Two Physician Organization Ownership Types Margaret C. Wang RAND/UCLA Post-Doctoral Fellow AcademyHealth Annual Research Meeting AcademyHealth ARM
Background • The “quality chasm” in health care • Paradigm shift in chronic care delivery • The crucial role of physician organizations (POs) AcademyHealth ARM
PO Ownership Structures Why does it matter? • Freestanding physician-owned • System-affiliated hospital-owned “Who owns the equipment and employs the non-physician staff of your PO (including MSO, if any)?” AcademyHealth ARM
Research Questions • What is the association between the type of PO ownership structure and: • Clinical IT, scheduling and follow-up capabilities, availability of case managers, and financial resources • External incentives for quality • How does ownership structure affect the implementation of the Chronic Care Model? AcademyHealth ARM
The Chronic Care Model (CCM) Source: Wagner et al., 1999 AcademyHealth ARM
The Chronic Care Management Index (CCMI) AcademyHealth ARM
Data Source • National Study of Physician Organizations and the Management of Chronic Illnesses • National census of physician organizations employing 20 or more physicians (2000 –2001) • Final sample size = 1,104 (70% response rate) • 67% medical group and 33% IPAs AcademyHealth ARM
Descriptive Statistics AcademyHealth ARM
Organizational Resources • Mean values for structural and human resources: • Percentage of POs reporting breaking even vs. loss: AcademyHealth ARM
Impact of External Incentives • Mean value for Quality Reporting Requirement Index: • Percentage of PO reporting receiving external incentives for quality: AcademyHealth ARM
Implementation of the CCM • Mean and standard deviation for the Chronic Care Management Index (CCMI): AcademyHealth ARM
Implementation of the CCM • Stepwise Multivariate Linear Regression: AcademyHealth ARM
Implementation of the CCM • Sub-sample analyses: AcademyHealth ARM
Conclusions • Ownership matters but organizational resources and external incentives are more important for CCM implementation • Receiving public recognition for quality • The role of clinical IT among the system-affiliated hospital-owned POs warrants further investigation AcademyHealth ARM
Policy Implications Promoting greater implementation of the Chronic Care Model requires: • Organizational resources • Clinical IT, scheduling capabilities, active follow-up, and case manager availability • Incentive mechanisms • Requiring quality reporting, providing public recognition for quality, and tying quality improvement with better contracts AcademyHealth ARM
Acknowledgements • Dissertation study was funded by Health Research and Education Trust (HRET) Fellowship • The NSPO project was funded by the Robert Wood Johnson Foundation (RWJF) AcademyHealth ARM