End the duopoly

Health Care Leader Perspectives on State Government–Sponsored Accountable Care for Public Employees

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ABSTRACT

Objectives : Most studies of accountable care organizations (ACOs) have focused on contracts with commercial payers, Medicare, or Medicaid. This study contributes to the literature by describing implementation of an ACO for public employees, contracted by a state government under a federally funded State Innovation Model grant.

Study Design: Over a 2-year period, we conducted 17 semistructured qualitative interviews with 20 clinical and administrative representatives of 5 participating health care systems.

Methods: We used an abductive qualitative coding approach to identify key themes in ACO implementation, with a focus on the role of state government.

Results: Interview participants discussed conditions for ACO adoption, components of implementation, likely effectiveness, and expectations about sustainability. The state government influenced ACO development by creating opportunities for innovation in care delivery, leveraging purchasing power, providing data, developing and maintaining strategic contracts, and encouraging public employees to enroll in accountable care plans. In some organizations, the ACO may have had a spillover effect, improving care for patients who were not public employees. Findings indicate that this state-led ACO shared traits with other public ACOs contracted under Medicare and Medicaid.

Conclusions: By implementing an ACO for public employees, state governments may catalyze improvements in […]

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