Accountable Care Organization

Accountable Care Organization

Introduction

Background of the study

The way healthcare providers in the US deliver health services offers a backdrop into the nation's annual healthcare cost of $2.1 trillion (Jensen & Mendonca, 2009). New drugs, new tests, new devices, and new ways of using them are delivered through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-ofservice (POS) plans. Patients with complicated conditions see many physicians and access several services spread across a number of institutions (Lee, 2010). Physicians make clinical decisions about their patients' tests, treatments, and therapies. These decisions represent up to 90% of every healthcare dollar spent (Boukus, Cassil, & O'Malley, 2009). In a speech at the White House, President Barack Obama stated, “the biggest threat to our nation's balance sheet is the skyrocketing cost of health” (Gawande, 2009). Medical costs present a practical problem for physicians as they face the conflict of serving the interests of both patients and healthcare corporations (Shortell, Waters, Clarke, & Budetti, 1998).

Problem Statement

To address these disparities, a new concept called accountable care organizations (ACOs) is gaining significant attention. ACOs are formal groupings of doctors, and potentially hospitals and other services such as laboratories and pharmacies, that agree to manage the full continuum of care and be accountable for the overall costs and quality of care for a defined population. What could be called a canopy concept, the ACO covers an organizational structure—real or virtual integration among providers—with payment and performance measurement that are expected to ensure accountability (Shortell, Casalino, & Fisher, 2010, May). As part of this change, physicians take a leadership role in improving the value of users' healthcare dollars. This requires balancing the benefits and costs of healthcare in accordance with the needs of patients (American Medical Association, 2008).

The concept of cost and quality in healthcare is not new, however, applying this concept of cost and quality to the accountability of outcome is new. On March 31, 2011, the U.S. Department of Health and Human Resources released the proposed new rules for ACOs (HHS Press Office, 2011). The quality standards outlined in the rules cover five key areas: patient/caregiver care experiences, care coordination, patient safety, preventive health, and at-risk population/frail elderly health. What we do not know is what the change to ACOs means to the medical profession, more specifically to physician leaders. Studies have examined the meaning of medicine as a profession, but the question arises as to the ways in which the professional role changes when administrative accountabilities are introduced that link to clinical outcomes. As the healthcare system changes to ACOs, how will the role of physician leaders change?

Hypothesis / Research Question

Question: How has the introduction of the concept of accountable care affected physician leaders' perceptions of their clinical and administrative roles in healthcare organizations?

Purpose of the study

The purpose of this proposed research will be to explore the ways in which practicing physicians perceive and make meaning of their leadership role during their healthcare system's move to an accountability ...