Date of Conferral

2019

Degree

Ph.D.

School

Health Services

Advisor

Dr. Michael Furukawa

Abstract

Changes to the country's health care political landscape in 2012 resulted in the development of federal programs aimed at containing costs and improving the quality of care delivered. Accountable Care Organizations (ACO) emerged linking performance to rewards. Guided by Conrad's value-based performance incentive theory as the theoretical foundation, the purpose of this quantitative study was to determine the relationship between financial incentive size and ACO performance measures. The research questions examined the predictive relationship of incentive size and acute care readmission rates, emergency department (ED) visits, and per capita spending of the ACO Medicare Shared Savings Program population. The study included 348 participating ACOs serving 7.8 million Medicare enrollees. Secondary archival data were analyzed using multiple linear regression models to test the relationship patterns of the three dependent variables. The findings showed a significant association between incentive size and acute readmission rates β = .001; 95% CI, .000185, .001342; p = .010; and a significant inverse association with per capita spending, β = -6.28E-7; 95% CI, -.000001, -1.61E-7; p = .009, but no association with the frequency of ED visits β = -5.06E-6; 95% CI, -.000011, 7.04E-7; p = .085. The study results support that incentive size is linked with higher acute care readmission rate and lower per capita spending but not frequency of ED visits. Incentive size was found to be associated with better and worse ACO provider performance depending on the outcome. Social change implications include improved performance on ACO spending, which might potentially lead to political and regulatory changes supporting larger financial incentives by the federal government.

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