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 2
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 3
Benefits? Organizational al Processes Cos Cost Outcomes Qual ality Outcomes es Better cost - N.S System Affiliation performance - N.S. N.S. Concentration More likely to: • Collect performance information • Share information with physicians - - ACO Membership • Use aspects of performance for compensation 4
Future Avenues of f Research? Outcomes – Outcomes – Outcomes – Types of Consolidations Time T Time 1 Time 2 Motivation Variety Mechanisms Time 5
Gre reater Attention to o 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 Illu Il lust strati tive Que Questi tions Are Are som some type types of of co consoli lidatio tions s more ore ef effe fecti tive at at ac achieving desi desired outc outcomes? s? Are Are som some form orms (or (or co combin inati tions of of form orms) of of inte integrati tion more ore im impo portant t for or ac achievin ing desi desired outc outcomes? s? How How do do dif diffe ferent t form orms of of inte integrati tion var vary as as a a functio ion of of dif diffe ferent t type types of of co consolid idati tion? 6
Mot otivation fo for r Con onsolidation ◉ 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 org rganiz izatio ional l pro rocesses es an and outc tcomes? 7
Get etting In Insid ide the Blac lack Box Consolidation Outcomes ▰ 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? ? 8 ▻ Do thes ese mec echanis isms diffe ffer for for different types of f consoli lidatio ion?
For example… Collect performance information Quality Share information ACO with physicians Cost Membership Use aspects of performance for compensation Structural Functional Outcomes Integration Integration 9
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? 10
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? 11
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 organizations 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
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