The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, WTRB Level 5, Lebanon, NH 03756, United States.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, United States.
Soc Sci Med. 2017 Oct;190:1-10. doi: 10.1016/j.socscimed.2017.04.054. Epub 2017 May 2.
Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs - 81% - involve new partnerships between independent health care organizations. These "partnership ACOs" generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care.
责任医疗组织（ACO）和类似的改革旨在改善医疗服务提供者之间的协调；然而，由于美国医疗保健系统的碎片化性质，成功的协调在很大程度上取决于医疗保健组织是否能够成功地跨越组织边界建立伙伴关系。对于 ACO 模式下形成的新伙伴关系，我们知之甚少。我们使用来自国家 ACO 调查、医疗保险 ACO 绩效数据和对 31 个 ACO 高管的访谈的混合方法数据，来考察伙伴关系 ACO 的普遍性、特征和能力，以及 ACO 伙伴关系形成的原因和方式。我们发现，令人惊讶的是，高达 81%的 ACO 涉及独立医疗保健组织之间的新伙伴关系。这些“伙伴关系 ACO”通常报告在医疗管理、医疗协调和健康信息技术方面的能力较低。此外，在医疗保险 ACO 计划下，伙伴关系 ACO 的质量表现略低。定性访谈显示，提供者有合作的动机，包括资源互补、降低风险和满足立法要求，并且正在使用各种正式和非正式的问责机制。大多数伙伴关系 ACO 是基于现有的、积极的关系而建立的，但也有少数 ACO 是基于以前的竞争或冲突关系而建立的。我们的研究结果表明，ACO 模式的成功在很大程度上取决于新伙伴关系的成功，这对理解 ACO 的准备情况和能力、迄今为止 ACO 计划实现的相对较小的储蓄以及提供者承担更多人口健康管理风险的途径都有重要影响。此外，ACO 伙伴关系可能为监测潜在的医疗保健整合浪潮提供一个重要窗口，或者相反，为独立提供者成功协调患者护理提供一个新模式。
