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A Tale of Two Physician Organization Ownership Types

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

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  1. A Tale of Two Physician Organization Ownership Types Margaret C. Wang RAND/UCLA Post-Doctoral Fellow AcademyHealth Annual Research Meeting AcademyHealth ARM

  2. Background • The “quality chasm” in health care • Paradigm shift in chronic care delivery • The crucial role of physician organizations (POs) AcademyHealth ARM

  3. 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

  4. 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

  5. The Chronic Care Model (CCM) Source: Wagner et al., 1999 AcademyHealth ARM

  6. The Chronic Care Management Index (CCMI) AcademyHealth ARM

  7. 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

  8. Descriptive Statistics AcademyHealth ARM

  9. Organizational Resources • Mean values for structural and human resources: • Percentage of POs reporting breaking even vs. loss: AcademyHealth ARM

  10. Impact of External Incentives • Mean value for Quality Reporting Requirement Index: • Percentage of PO reporting receiving external incentives for quality: AcademyHealth ARM

  11. Implementation of the CCM • Mean and standard deviation for the Chronic Care Management Index (CCMI): AcademyHealth ARM

  12. Implementation of the CCM • Stepwise Multivariate Linear Regression: AcademyHealth ARM

  13. Implementation of the CCM • Sub-sample analyses: AcademyHealth ARM

  14. 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

  15. 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

  16. 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

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