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HSRProj (Health Services Research Projects in Progress)

Information about ongoing health services research and public health projects


Analyzing the variation in the performance of accountable care organizations serving rural Medicare beneficiaries
Investigator (PI): Mueller, Keith J
Performing Organization (PO): (Current): University of Iowa, College of Public Health, Department of Health Management and Policy, RUPRI Center for Rural Health Policy Analysis / (319) 384-3832
Supporting Agency (SA): Health Resources and Services Administration (HRSA), Office of Rural Health Policy
Initial Year: 2015
Final Year: 2016
Award Type: Grant
Abstract: Problem statement: The Medicare Shared Savings Program (MSSP) continues to attract attention, now as a means of meeting goals to transition Medicare fee-for-services (FFS) to alternative payment systems. Increased flexibility has been built into the program since its inception, such that ACOs now include even more that serve rural areas, more that are governed and owed by independent physician associations, more that are small (fewer than 10,000 attributed beneficiaries), and more that are part of national consortia. As the program enters its fourth year, performance data are now available for over 200 ACOs. Research questions about the relationship between ACO characteristics and performance can now be addressed. We will test hypotheses that size, direct involvement of physicians through governance structure, and investment in data analytics predict higher performance. The goals of this project are to characterize ACOs that operate in rural areas (defined by the locations of primary care providers to whom beneficiaries are attributed and organizations participating in the ACO), describe the models being used to organize those ACOs (e.g., arrangements among participating providers, engagement of other providers in the region, relationship to large health care systems, participation in regional or national consortia), and to test relationships of those characteristics to performance measures related to financial success (i.e., shared savings) and quality (the indicators used by CMS). We will identify potential changes in legislative and regulatory policies that could strengthen the utility of the ACO model to achieve high performing rural health care delivery organizations.
MeSH Terms:
  • * Accountable Care Organizations
  • Delivery of Health Care /organization & administration
  • Fee-for-Service Plans
  • Health Care Costs
  • * Healthcare Disparities
  • Humans
  • Medicare /*organization & administration
  • Models, Organizational
  • Primary Health Care /organization & administration
  • Program Evaluation
  • Regional Medical Programs
  • Rural Health Services /*organization & administration
  • Rural Population
  • United States
Keywords:
  • Medicare
  • health care financing
  • health policy
  • legislation and regulation
  • quality
Country: United States
State: Iowa
Zip Code: 52246
UI: 20161004
Project Status: Completed