Volume 19, Number 2, Summer 2016

Managing Boundaries in Integrated Care: A Qualitative Studyof Collaboration
between Municipalities and County Councils in Sweden .……………………………………….      139
A. Alvinius, B. W. Larsson, and G. Larsson
 
                                                                     SYMPOSIUM
 
Organizational Theory in Health Care Management: A Symposium ………………………….    166
S. Camilleri and K. Colville
 
Organizational Theory in Health Care Management: Symposium Introduction ………....   167
S. Camilleri and K. Colville
 
Hospital Ownership of Post-Acute Care Facilities and Re-Admission Rates: A
Resource Dependence and TransactionCost Approach ..……………………………….…..........  177
S. Camilleri and K. Colville
 
Coordination Mechanisms in Four Accountable Care Organizations ……………………….…  207
B. Hilligoss, P. H. Song, and A. S. McAlearney
 
A Conceptual Model for Achieving Value for Provider Organizations Participating
in Health Information Exchange ..................................………......................................….  233
D. M. Walker, T. R. Huerta, and M. L. Diana
 
New organization theory posits that coordination mechanisms work by generating three integrating conditions: accountability (clarity about task responsibilities), predictability (clarity about which, when, and how tasks will be accomplished), and common understanding (shared perspectives about tasks). We apply this new theory to health care to improve understanding of how accountable care organizations (ACOs) are attempting to reduce the fragmentation that characterizes the US health care system. Drawing on four organizational case studies, we find that ACOs rely on a wide variety of coordination mechanisms that have been designed to leverage existing organizational capabilities, accommodate local contingencies. and, in some instances,interact strategically.We conclude that producing integrating conditions across the care continuum requires suites of interacting coordination mechanisms. Our findings provide a conceptual foundation for future research and improvements.

Swedish healthcare has undergone continuous development over several decades. Today, legal responsibility is shared on the local and regional levels, i.e. between municipalities and county councils. The purpose of the present study is to gain a deeper understanding of boundary spanning roles and strategies involved in municipal and county council collaboration. A grounded theory approach was used. Fifteen informants from several Swedish health care authorities were interviewed. A tensionexists between preserving boundary strategies that stifle collaboration and boundary spanning strategies that facilitate it. The way boundary spanners manage their role is assumed to influence the centre of gravity for this tension and thus the combination of favourable boundary spanning strategies and favourable boundary spanning roles is one way of getting the current form of collaboration to work.

Due to recent Affordable Care Act reforms, prevention of readmissions is a salient issue for hospitals that participate in Medicare, as they are now held accountable for patients who receive post-acute care in facilities over which hospitals have little influence to monitor care. Using resource dependence and transaction cost economics to describe the theoretical advantages of hospital ownership of post-acute care facilities (PACs), we empirically test whether hospitals that own PACs experience reduced readmissions. Our findings indicate partial support for the predicted relationship between PAC ownership and readmission rates. We found that hospital ownership of a skilled-nursing facility (SNF) was related to a lower readmissions rate for some patients, while ownership of other types of PACs did not result in significant findings. Our results offer support for the theoretical advantages of ownership, however, the savings realized by ownership may not merit the ownership investment.

Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organization’s internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs.

Politicians, pundits, and members of the public focused on the Affordable Care Act’s (ACA) expansion of health insurance accessibility may neglect to recognize that the ACA’s most dramatic reforms have little to do with insurance coverage. Programs within the ACA attempt to promote effectiveness and efficiency by reducing fragmentation in healthcare, and have introduced profound changes to the incentive structure,strategies, and internal and external relationshipsbetween healthcare providers. Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), bundled payment systems, and the Hospital Readmission Reduction Program (HRRP) aim to foster higher levels of coordination among the multiple individuals and organizations that provide care to the same patient.

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