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Evaluating provider and organizational response in select population health management initiatives

Leighton, Cassandra (2019) Evaluating provider and organizational response in select population health management initiatives. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Research has yielded mixed results as to the overall impact and sustainability of population health management initiatives. However, some organizations have been better able to alter care processes and provider behavior to achieve population cost and quality goals. To ensure the maximal impact of these initiatives and provide evidence-based guidance to healthcare organizations across the country, it is imperative to examine the contextual factors that drive change and performance. This dissertation will evaluate provider and organizational response to population health models aimed at the provision of home, community, and outpatient care.

Chapter 1 provides the purpose, summary of research and findings, and implications of the dissertation.

Chapter 2 is a qualitative study of the Caregiver Advise, Record, Enable (CARE) Act implementation within three purposively-selected UPMC medical-surgical units. Observations, interviews, and document review are triangulated to understand organizational processes, structures, and performance related to lay-caregiver education and preparation for patient discharge, in accordance with the legislation.

Chapter 3 evaluates the association between the structure of Medicare Shared Savings Program (MSSP) ACOs’ contracted-provider network and the retention of attributed Medicare fee-for-service beneficiaries. We use Medicare administrative claims data from 2013 to 2014. Results of the adjusted logistic regression indicate that ACO provider network comprehensiveness increases the odds of a beneficiary remaining attributed to the same ACO year-to-year. This finding could inform structural and organizational formation of future iterations of ACOs.

Finally, Chapter 4 measures provider-level changes resulting from a 2012 Pennsylvania fee standardization. We test two hypotheses using generalized linear models for the following outcomes: change in providers operating in a county and change in volume of units billed per beneficiary. Based upon the evidence, we summarize provider response to an exogenous rate change.

Public Health Significance:
This dissertation contributes to the literature by focusing on the supply-side structural and procedural changes that occur when new policy and payment mechanisms are put into place. Results from this dissertation can be used to establish best practices and inform future policy, rate-setting, and implementation decisions that enhance the success of these population health management initiatives.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Leighton, Cassandracal159@pitt.educal1590000-0002-7016-1569
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDriessen, Juliadriessen@pitt.edudriessen
Committee MemberJames, A. Everetteaejames@pitt.eduaejames
Committee MemberDegenholtz, Howardhoward.degenholtz@pitt.edudegen
Committee MemberCole, Evanevancole@pitt.eduevancole
Committee MemberHawk, Marymary.hawk@pitt.edumary.hawk
Date: 26 June 2019
Date Type: Publication
Defense Date: 25 February 2019
Approval Date: 26 June 2019
Submission Date: 13 March 2019
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 96
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Caregiver ACO HCBS
Date Deposited: 26 Jun 2019 17:49
Last Modified: 01 May 2022 05:15

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