Walker Daniel M, Hefner Jennifer L, Sova Lindsey N, Hilligoss Brian, Song Paula H, McAlearney Ann Scheck
Daniel M. Walker, PhD, assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus; Jennifer L. Hefner, PhD, assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University; Lindsey N. Sova, research associate, Department of Family Medicine, College of Medicine, The Ohio State University; Brian Hilligoss, PhD, associate professor, Department of Management and Organizations, Eller College of Management, University of Arizona, Tucson; Paula H. Song, PhD, associate professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; and Ann Scheck McAlearney, ScD, professor and vice chair of research, Department of Family Medicine, College of Medicine, and Division of Health Services Management and Policy, College of Public Health, The Ohio State University.
J Healthc Manag. 2017 Nov/Dec;62(6):419-431. doi: 10.1097/JHM-D-16-00021.
Accountable care organizations (ACOs) are emerging across the healthcare marketplace and now include Medicare, Medicaid, and private sector payers covering more than 24 million lives. However, little is known about the process of organizational change required to achieve cost savings and quality improvements from the ACO model. This study applies the complex innovation implementation framework to understand the challenges and facilitators associated with the ACO implementation process. We conducted four case studies of private sector ACOs, selected to achieve variation in terms of geography and organizational maturity. Across sites, we used semistructured interviews with 68 key informants to elicit information regarding ACO implementation. Our analysis found challenges and facilitators across all domains in the conceptual framework. Notably, our findings deviated from the framework in two ways. First, findings from the financial resource availability domain revealed both financial and nonfinancial (i.e., labor) resources that contributed to implementation effectiveness. Second, a new domain, patient engagement, emerged as an important factor in implementation effectiveness. We present these deviations in an adapted framework. As the ACO model proliferates, these findings can support implementation efforts, and they highlight the importance of focusing on patients throughout the process. Importantly, this study extends the complex innovation implementation framework to incorporate consumers into the implementation framework, making it more patient centered and aiding future efforts.
accountable care organizations (ACOs) 正在医疗保健市场中兴起，目前包括医疗保险、医疗补助以及覆盖超过2400万人的私营部门支付方。然而，对于通过ACO模式实现成本节约和质量提升所需的组织变革过程，人们了解甚少。本研究应用复杂创新实施框架来理解与ACO实施过程相关的挑战和促进因素。我们对私营部门的ACO进行了四项案例研究，这些案例在地理位置和组织成熟度方面具有差异。在各个地点，我们对68名关键信息提供者进行了半结构化访谈，以获取有关ACO实施的信息。我们的分析在概念框架的所有领域都发现了挑战和促进因素。值得注意的是，我们的研究结果在两个方面与该框架有所不同。首先，财务资源可用性领域的研究结果揭示了有助于实施有效性的财务和非财务（即劳动力）资源。其次，一个新的领域——患者参与，成为实施有效性的一个重要因素。我们在一个经过调整的框架中呈现这些差异。随着ACO模式的普及，这些研究结果可以支持实施工作，并突出了在整个过程中关注患者的重要性。重要的是，本研究扩展了复杂创新实施框架，将消费者纳入实施框架，使其更以患者为中心，并有助于未来的工作。
