Evaluating provider and organizational response in select population health management initiativesLeighton, Cassandra (2019) Evaluating provider and organizational response in select population health management initiatives. Doctoral Dissertation, University of Pittsburgh. (Unpublished) This is the latest version of this item.
AbstractResearch 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: Share
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