An exploratory study of the growth of the Accountable Care Organization and its impact on physician groups’ profit: a complex adaptive system approach

The emergence of Accountable Care Organizations(ACOs)in the landscape of the U.S.healthcare system marks a paradigm shift in healthcare operations.The potential impact of ACOs has been a topic of intense debate.Traditional analytical approaches do not lend themselves to examining the complex phenomenon of the emergence and growth of ACOs in the healthcare network.We adopt a complex adaptive system lens to examine the growth of ACOs among physician groups and explore factors that influence this growth.We also discuss the impact of ACOs on the profit of physician groups.An agent-based model was built to simulate physician groups'ACO entrance and exit based on a set of simple rules and their complex interactions with other agents.Based on the simulation results,we derive patterns of ACO expansion and contraction,following four stages of wait-and-see,rollercoaster,fast growth,and stabilizing.Findings suggest that the growth of ACOs is sensitive to the initial state of ACO membership.When the initial size of ACO membership increases,it helps to eliminate the rollercoaster stage.In addition,the growth of the ACO varies depending on the cost–quality tradeoff.When both cost and quality objectives can be met simultaneously,the growth of ACO membership follows wait-and-see and fast growth stages followed by a different stage that we term sticky state.The impact of ACOs on physician groups’cumulative profit varies by the service quality level of the physician group.Physician groups affiliated with insurance companies charging the lowest or the highest level of health insurance premiums are worse off with the ACO option.However,the ACO benefits physician groups affiliated with an insurance company charging a moderate level of premiums.

Bridging Healthcare and Health IT

Health IT （Information Technology） is new to the healthcare industry, even though the term surfaced in 2008 the true meaning of what it is and how data aggregation, evaluation, and validation of patient data and information drives a successful quality healthcare organization. Understanding of key factors, what quality is and how it is measured, helps bridge together healthcare and technology for an organization to be successful in reporting quality measures for the best patient care.

The Accountable Care Organization results:Population health management and quality improvement programs associated with increased quality of care and decreased utilization and cost of care

Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.