All Things Configured Synthesis & Dis iscussion of f Futu - - PowerPoint PPT Presentation

All Things Configured

Synthesis & Dis iscussion of f Futu ture Research Opportunities

My Objectives

◉ Highlight commonalities and

differences between the studies

◉ Facilitate a discussion of future

extensions of this work

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Commonalities & Diff ifferences

Commonalities

◉ Study purpose ◉ What types of benefits, if any, do consolidations among health care

delivery organizations, provide?

◉ Underlying Assumption ◉ That these benefits will derive from more integrated, and thus, better

coordinated, care

Differences

▰ Contexts ▰ Outcomes ▰ Study time horizons

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Benefits?

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Organizational al Processes Cos Cost Outcomes Qual ality Outcomes es System Affiliation

• Better cost

performance N.S

Concentration

• N.S.

N.S.

ACO Membership More likely to:

• Collect performance information
• Share information with physicians
• Use aspects of performance for

compensation

Future Avenues of f Research?

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Types of Consolidations Outcomes – Time 1 Outcomes – Time 2 Outcomes – Time T

Motivation Variety Mechanisms Time

Gre reater Attention to

• Var

ariety

◉ Different types of consolidations ◉ E.g., Different types of multihospital systems (Bazzoli et al., 1999) ◉ E.g., Different types of ACOs (Shortell et al., 2014) ◉ Different types of integration ◉ E.g., Singer, Kerrisey, Friedberg, & Phillips, 2018

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Il Illu lust strati tive Que Questi tions

• Are

Are som some type types of

• f co

consoli lidatio tions s more

• re ef

effe fecti tive at at ac achieving desi desired outc

• utcomes?

s?

• Are

Are som some form

• rms (or

(or co combin inati tions of

• f form
• rms) of
• f inte

integrati tion more

• re im

impo portant t for

• r ac

achievin ing desi desired outc

• utcomes?

s?

• How

How do do dif diffe ferent t form

• rms of
• f inte

integrati tion var vary as as a a functio ion of

• f dif

diffe ferent t type types of

• f co

consolid idati tion?

Mot

• tivation fo

for r Con

• nsolidation

◉ Different motivations for consolidation ◉ E.g., Efficiency vs. strategic motivations (Post, Buchmueller, and Ryan,

2018)

◉ E.g., Institutional vs. market demands (Alexander & D’Aunno, 2003)

Il Illu lustr trativ ive Ques uesti tions

• Do th

the motiv ivatio ions va vary for for different ty types of f consoli lidatio ion?

• How migh

ght t diffe fferent moti tivatio ions for for pur ursuin ing consoli lidatio ion affe affect

• rg

rganiz izatio ional l pro rocesses es an and outc tcomes?

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Get etting In Insid ide the Blac lack Box

▰ Need to look “under the hood” of these consolidations to understand the

mechanisms (Shortell, 2014) Il Illu lustr trativ ive Que uesti tions

▻ Why (or why don’t) consolidations impact outcomes? ▻ If

If they impact t outc tcomes, , how do they do so? ?

▻ Do thes

ese mec echanis isms diffe ffer for for different types of f consoli lidatio ion?

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Consolidation Outcomes

For example…

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ACO Membership Quality Cost

Collect performance information Structural Integration Functional Integration Outcomes Share information with physicians Use aspects of performance for compensation

Tim ime

◉ Organizations like ACOs learn at different rates (Nembhard & Tucker, 2016) ◉ Impact of consolidations may be delayed or diminish over time ◉ More substantive consideration of time

Il Illu lustr trativ ive Que uesti tions

◉ How do consoli

lidatio ions ev evolv lve e ove ver time?

◉ Do diffe

fferent ty types of f consoli lidatio ions experie ience diffe fferent gro rowth tra traje jectorie ies?

◉ Does the

e impact of f consolid idatio ions on n outc tcomes chan ange e ove ver time?

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Questions fo for r Discussion

◉ What do you see as the primary challenges to pursuing these lines of research? ◉ What other opportunities do you see to better understand the impact of consolidation?

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Refe ferences ▰ Alexander, J.A., & D’Aunno, T. (2003). Alternative Perspectives on Institutional and Market Relationships in

the U.S. Health Care Sector. In Mick, S.S. & Wyttenbach, M. Advances in Health Care Organization Theory. Jossey-Bass: San Francisco, CA.

▰ Bazzoli, G. J., Shortell, S. M., Dubbs, N., Chan, C., & Kralovec, P. (1999). A taxonomy of health networks

and systems: bringing order out of chaos. Health services research, 33(6), 1683.

▰ Nembhard, I.M., & Tucker, A.L. (2016). Applying Organizational Learning Research to Accountable Care

• Organizations. Medical Care Research and Review, 73(6), 673-684.

▰ Post, B., Buchmueller, T., & Ryan, A.M. (2018). Vertical integration of hospitals and physicians: Economic

theory and empirical evidence on spending and quality. Medical Care Research and Review, 75(4), 399- 433.

▰ Shortell, S.M. (2014). Commentary on “Horizontal and vertical integration of physicians: A tale of two tails.”

Advances in Health Care Management, 15, 119-124.

▰ Shortell, S. M., Wu, F. M., Lewis, V. A., Colla, C. H., & Fisher, E. S. (2014). A taxonomy of accountable care

• rganizations for policy and practice. Health Services Research, 49(6), 1883-1899.

▰ Singer, S.J., Kerrissey, M., Friedberg, M., & Phillips, R. (2018). A Comprehensive Theory of Integration.

Medical Care Research and Review, 12