Date of Conferral

10-29-2024

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Human Services

Advisor

Laurie Latvis

Abstract

Annual national health spending continues to increase, and evidence does not support the notion that the majority of reform programs, which have concentrated on quality-based payment schemes, have improved healthcare quality or health outcomes in a way that is necessary. Consequently, health care expenses are still linked to high expenditures despite the intended improvements in outcomes not occurring. Using the Donabedian model of structure-process-outcome as the conceptual framework, the relationship between the quality score and the generated total savings and generated total losses for Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) Participants from 2019 through 2021 was investigated. The relationship between the quality score and total assigned beneficiaries for MSSP ACO participants during the same time period, as well as the relationship between the quality score and expenditures per capita between 2019 and 2021 were also examined. The results showed for MSSP ACO participants for the years 2019 through 2021, there are statistically significant correlations between the quality score and generated total savings, generated total losses, expenditures per capita, and total assigned beneficiaries. Quality score is a predictor of total assigned beneficiaries, expenditures per capita, generated total losses, and generated total savings. More significantly, the analysis shows MSSP ACOs can be a powerful tool for leaders looking to lower related healthcare costs and raise standards in the U.S. healthcare system. The social impact this study facilitated is organizations better understand how to address the healthcare quality the people they serve deserve, by lowering healthcare costs and better outcomes by implementing MSSP ACOs.

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