Survey of twelve children’s hospital-based accountable care organizations
Bibliographic record
Abstract
Accountable care organizations (ACOs) are a primary focus of value-based healthcare reform strategies, however research is lacking on pediatric-specific ACO development. To present the current landscape of children’s hospital-based pediatric ACOs, researchers conducted semi-structured telephone interviews with executive-level staff from twelve ACOs from November 2013 to February 2014. Interview questions spanned five topics: (1) pathway/strategy; (2) organizational structure; (3) shared savings; (4) provider network; (5) data and quality. Three qualitative frameworks were applied to assess the degree of similarity among pediatric ACO models and between these and promulgated adult ACO components: (1) operational diagrams; (2) spectrums of characteristics; (3) financial and organizational categorization. Organizational structures consisted of five Physician-Hospital Organizations, two System-Based Pediatric Contracts, three Provider-Sponsored Managed Care Organizations, and two Hospital Medical Staff Organizations. Oversight models developed for the ACOs included six separate boards, two board subcommittees, and one dispersed governance. Financial contracts between payers and participants included four shared savings only, one risk corridor, and seven full capitation. Eight participants had provider incentive programs primarily for cost reductions. Nine participants used National Committee for Quality Assurance (NCQA)’s Healthcare Effectiveness Data Information Set (HEDIS) metrics, emphasized utilization management, and invested in separate care coordination resources. Overall, marked variation in pediatric ACO models is developing nationally, and cost savings goals exceed the importance of quality improvement. National pediatric collaboration and state facilitation for ACO quality measures is crucial to improving health outcomes in the pediatric ACO.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".