The Hidden Roles That Management Partners Play In Accountable Care Organizations

doi:10.1377/hlthaff.2017.1025

. 2018 Feb;37(2):292-298.

doi: 10.1377/hlthaff.2017.1025.

The Hidden Roles That Management Partners Play In Accountable Care Organizations

Valerie A Lewis¹, Thomas D'Aunno², Genevra F Murray³, Stephen M Shortell⁴, Carrie H Colla⁵

Affiliations

¹ Valerie A. Lewis ( Valerie.A.Lewis@dartmouth.edu ) is an associate professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, in Lebanon, New Hampshire.
² Thomas D'Aunno is a professor of management and director of the Health Policy and Management Program at the Robert F. Wagner Graduate School of Public Service, New York University, in New York City.
³ Genevra F. Murray is a research project director at the Dartmouth Institute for Health Policy and Clinical Practice.
⁴ Stephen M. Shortell is the Blue Cross of California Distinguished Professor Emeritus of Health Policy and Management, a professor of organization behavior at the School of Public Health and Professor of the Graduate School, codirector of the Center for Healthcare Organizational and Innovation Research, and dean emeritus at the School of Public Health, all at the University of California, Berkeley.
⁵ Carrie H. Colla is an associate professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice.

PMID: 29401012
PMCID: PMC5905409
DOI: 10.1377/hlthaff.2017.1025

The Hidden Roles That Management Partners Play In Accountable Care Organizations

Valerie A Lewis et al. Health Aff (Millwood). 2018 Feb.

. 2018 Feb;37(2):292-298.

doi: 10.1377/hlthaff.2017.1025.

Authors

Valerie A Lewis¹, Thomas D'Aunno², Genevra F Murray³, Stephen M Shortell⁴, Carrie H Colla⁵

Affiliations

¹ Valerie A. Lewis ( Valerie.A.Lewis@dartmouth.edu ) is an associate professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, in Lebanon, New Hampshire.
² Thomas D'Aunno is a professor of management and director of the Health Policy and Management Program at the Robert F. Wagner Graduate School of Public Service, New York University, in New York City.
³ Genevra F. Murray is a research project director at the Dartmouth Institute for Health Policy and Clinical Practice.
⁴ Stephen M. Shortell is the Blue Cross of California Distinguished Professor Emeritus of Health Policy and Management, a professor of organization behavior at the School of Public Health and Professor of the Graduate School, codirector of the Center for Healthcare Organizational and Innovation Research, and dean emeritus at the School of Public Health, all at the University of California, Berkeley.
⁵ Carrie H. Colla is an associate professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice.

PMID: 29401012
PMCID: PMC5905409
DOI: 10.1377/hlthaff.2017.1025

Abstract

Accountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs. We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94 percent had data services provided by the partner, 87 percent received administrative services, 68 percent received educational services, and 66 percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.

Keywords: Health Reform; Organization and Delivery of Care; Physicians.

PubMed Disclaimer

Figures

**Exhibit 1**
Proportion of ACOs with management partners increased across ACO cohorts, as did share of ACOs with a management partner providing financing or multiple core services Source: Authors’ analysis of National Survey of ACOs, Waves 1–3 Notes: “Multiple core services” means the management partner is providing all four services described in the text and Exhibit 2, including data analytics, care coordination, administrative services, and provider education.

**Exhibit 2**
Prevalence of financing and services from management partners among ACOs with management partners Source: Authors calculations Notes: * p<0.05; ** p<0.01; ***p<0.001

**Exhibit 3**
Provider composition and clinical services offered in ACOs with and without management partners show ACOs with management partners are smaller and more primary care centered Source: authors’ analysis of the National Survey of ACOs, Waves 1–3 Notes: * p<0.05; ** p<0.01; ***p<0.001

See this image and copyright information in PMC

Cited by

Accountable Care Organization Leader Perspectives on the Medicare Shared Savings Program: A Qualitative Study.
Khullar D, Schpero WL, Casalino LP, Pierre R, Carter S, Civelek Y, Zhang M, Bond AM. Khullar D, et al. JAMA Health Forum. 2024 Mar 1;5(3):e240126. doi: 10.1001/jamahealthforum.2024.0126. JAMA Health Forum. 2024. PMID: 38488778 Free PMC article.
Provision of Digital Health Technologies for Opioid Use Disorder Treatment by US Health Care Organizations.
Miller-Rosales C, Morden NE, Brunette MF, Busch SH, Torous JB, Meara ER. Miller-Rosales C, et al. JAMA Netw Open. 2023 Jul 3;6(7):e2323741. doi: 10.1001/jamanetworkopen.2023.23741. JAMA Netw Open. 2023. PMID: 37459098 Free PMC article.
Benchmarking Changes And Selective Participation In The Medicare Shared Savings Program.
Lyu PF, Chernew ME, McWilliams JM. Lyu PF, et al. Health Aff (Millwood). 2023 May;42(5):622-631. doi: 10.1377/hlthaff.2022.01061. Health Aff (Millwood). 2023. PMID: 37126741 Free PMC article.
Accountable Care Organizations and Preventable Hospitalizations Among Patients With Depression.
Barath D, Amaize A, Chen J. Barath D, et al. Am J Prev Med. 2020 Jul;59(1):e1-e10. doi: 10.1016/j.amepre.2020.01.028. Epub 2020 Apr 23. Am J Prev Med. 2020. PMID: 32334954 Free PMC article.
Massachusetts Community-Based Organization Perspectives on Medicaid Redesign.
Byhoff E, Taylor LA. Byhoff E, et al. Am J Prev Med. 2019 Dec;57(6 Suppl 1):S74-S81. doi: 10.1016/j.amepre.2019.07.017. Am J Prev Med. 2019. PMID: 31753282 Free PMC article.

See all "Cited by" articles

References

1. Fisher ES, Staiger DO, Bynum JPW, Gottlieb DJ. Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Aff (Millwood) 2007 Jan 1;26(1):44–57. - PMC - PubMed
1. McClellan MB, McKethan AN, Lewis JL, Roski J, Fisher ES. A National Strategy to put Accountable Care into Practice. Health Aff (Millwood) 2010 May;29(5):982–90. - PubMed
1. Colla CH, Lewis VA, Tierney E, Muhlestein DB. Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data. Health Aff Proj Hope. 2016 Mar 1;35(3):431–9. - PMC - PubMed
1. National Association of ACOs. First National ACO Survey on Startup Costs [Internet] 2014 [cited 2017 Jul 18]. Available from: http://www.prnewswire.com/news-releases/first-national-aco-survey-on-sta....
1. Moore KD, Coddington DC. The Work Ahead: Activities and Costs to Develop and Accountable Care Organization. Washington, D.C.: American Hospital Association; 2011. Apr,

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information

[1] Fisher ES, Staiger DO, Bynum JPW, Gottlieb DJ. Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Aff (Millwood) 2007 Jan 1;26(1):44–57. - PMC - PubMed

[2] Fisher ES, Staiger DO, Bynum JPW, Gottlieb DJ. Creating Accountable Care Organizations: The Extended Hospital Medical Staff. Health Aff (Millwood) 2007 Jan 1;26(1):44–57. - PMC - PubMed

[3] McClellan MB, McKethan AN, Lewis JL, Roski J, Fisher ES. A National Strategy to put Accountable Care into Practice. Health Aff (Millwood) 2010 May;29(5):982–90. - PubMed

[4] McClellan MB, McKethan AN, Lewis JL, Roski J, Fisher ES. A National Strategy to put Accountable Care into Practice. Health Aff (Millwood) 2010 May;29(5):982–90. - PubMed

[5] Colla CH, Lewis VA, Tierney E, Muhlestein DB. Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data. Health Aff Proj Hope. 2016 Mar 1;35(3):431–9. - PMC - PubMed

[6] Colla CH, Lewis VA, Tierney E, Muhlestein DB. Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data. Health Aff Proj Hope. 2016 Mar 1;35(3):431–9. - PMC - PubMed

[7] National Association of ACOs. First National ACO Survey on Startup Costs [Internet] 2014 [cited 2017 Jul 18]. Available from: http://www.prnewswire.com/news-releases/first-national-aco-survey-on-sta....

[8] National Association of ACOs. First National ACO Survey on Startup Costs [Internet] 2014 [cited 2017 Jul 18]. Available from: http://www.prnewswire.com/news-releases/first-national-aco-survey-on-sta....

[9] Moore KD, Coddington DC. The Work Ahead: Activities and Costs to Develop and Accountable Care Organization. Washington, D.C.: American Hospital Association; 2011. Apr,

[10] Moore KD, Coddington DC. The Work Ahead: Activities and Costs to Develop and Accountable Care Organization. Washington, D.C.: American Hospital Association; 2011. Apr,

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The Hidden Roles That Management Partners Play In Accountable Care Organizations

Affiliations

The Hidden Roles That Management Partners Play In Accountable Care Organizations

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical