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 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