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A Two-Step Method to Identify Positive Deviant Physician Organizations of Accountable Care Organizations with Robust
Alexander F Pimperl1, Hector P Rodriguez1, Julie A Schmittdiel2
1School of Public Health - Health Policy and Management, University of California, Berkeley, CA.
Objective:
To identify positive deviant (PD) physician organizations of Accountable Care Organizations (ACOs) with robust performance management systems (PMSYS).
Data Source:
Third National Survey of Physician Organizations (NSPO3, n = 1,398).
Study Design:
Organizational and external factors from NSPO3 were analyzed.
Data Collection/Extraction Methods:
Linear regression estimated the association of internal and contextual factors on PMSYS. Two cutpoints (75th/90th percentiles) identified PDs with the largest residuals and highest PMSYS scores.
Principal Findings:
A total of 65 and 41 PDs were identified using 75th and 90th percentiles cutpoints, respectively. The 90th percentile more strongly differentiated PDs from non-PDs. Having a high proportion of vulnerable patients appears to constrain PMSYS development.
Conclusions:
Our PD identification method increases the likelihood that PD organizations selected for in-depth inquiry are high-performing organizations that exceed expectations.
Insights
This study identified high-performing physician organizations within Accountable Care Organizations (ACOs) that excel in performance management systems (PMSYS). Findings suggest that a high proportion of vulnerable patients may hinder PMSYS development.
Area of Science:
- Healthcare Management
- Health Services Research
- Organizational Performance
Background:
- Accountable Care Organizations (ACOs) aim to improve healthcare quality and reduce costs.
- Effective performance management systems (PMSYS) are crucial for ACO success.
- Identifying high-performing ACOs can provide valuable insights into best practices.
Purpose of the Study:
- To identify positive deviant (PD) physician organizations within ACOs that possess robust PMSYS.
- To understand the organizational and external factors associated with high-performing PMSYS in ACOs.
Main Methods:
- Analysis of data from the Third National Survey of Physician Organizations (NSPO3, n=1,398).
- Utilized linear regression to assess the association of internal and contextual factors on PMSYS.
- Employed 75th and 90th percentile cutpoints to identify PDs based on residuals and PMSYS scores.
Main Results:
- Identified 65 PDs using the 75th percentile and 41 PDs using the 90th percentile.
- The 90th percentile cutpoint more effectively distinguished PDs from non-PDs.
- A higher proportion of vulnerable patients was associated with constraints on PMSYS development.
Conclusions:
- The developed PD identification method enhances the selection of high-performing organizations for further study.
- This approach aids in identifying ACOs that exceed performance expectations.
- Understanding factors influencing PMSYS is key to improving ACO performance.