An Examination of Potential Medical Group Practice Participation in Accountable Care Organizations




Anderson, Douglas Graeme

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The Patient Protection and Affordable Care Act of 2010 included legislation to create a new organizational structure, the Accountable Care Organization (ACO). This attempt to achieve the "triple aim" to improve the experience of care, improve the health of populations, and reduce the per capita costs of care establishes ACOs as a mechanism to provide coordinated care focusing on quality and outcomes in place of outputs. Medical group practices will be the focus of ACO formation. This research examines factors which make medical groups more likely to participate in ACOs. Utilizing data from a survey of medical group practices on the evolving healthcare environment, a logistic regression model is developed that indicates significant predictors of medical group participation in ACO development. Organizational size, engagement in joint venture activities, experience in Patient Centered Medical Homes, and organizational structural elements including the ability to manage clinical information, track quality measurements, and experience with payer incentive payments were all significantly associated with ACO participation. Organizational efficiency measures such as ability to track costs per episode of care were not found to be predictors of ACO participation. These results suggest an initial engagement in this new healthcare delivery model by medical groups with certain elements that align with a changed environment. Larger participation may be limited by the small size of most medical groups and the lack of internal resources to meet ACO requirements. Policy considerations to ease medical group participation in ACOs are reviewed. Future research is suggested to focus on the motivations and barriers to medical group practice participation in emerging organizational constructs for the delivery of healthcare services.



Public policy, Accountable care organizations, Affordable Care Act, Medical group practice, Organizational theory, Population ecology