Daniel M Walker1, Jennifer L Hefner, Lindsey N Sova, Brian Hilligoss, Paula H Song, Ann Scheck McAlearney. 1. 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.
Abstract
EXECUTIVE SUMMARY: 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.
EXECUTIVE SUMMARY: 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.
Authors: Dorine J van Staalduinen; Petra van den Bekerom; Sandra Groeneveld; Martha Kidanemariam; Anne M Stiggelbout; M Elske van den Akker-van Marle Journal: BMC Health Serv Res Date: 2022-03-01 Impact factor: 2.655