TY - JOUR
KW - Accountable Care Organizations/economics/statistics & numerical data
KW - Aged
KW - Aged, 80 and over
KW - Choice Behavior
KW - Computer Simulation
KW - Female
KW - Heart Failure/economics/mortality/therapy
KW - Hospitalization
KW - Humans
KW - Male
KW - Medicare
KW - patients
KW - Quality of Health Care
KW - Treatment Outcome
KW - United States
KW - accountable care organization
KW - Agent-based simulation model
KW - Congestive heart failure
KW - Health policy simulation
KW - Patient choice
AU - A. Alibrahim
AU - S. Wu
A1 - 
AB - Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.
AD - Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, 90089-0411, USA.; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, 90089-0411, USA. shinyiwu@usc.edu.; Edward R. Roybal Institute on Aging, School of Social Work, University of Southern California, Los Angeles, CA, 90089-0411, USA. shinyiwu@usc.edu.; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90089-0411, USA. shinyiwu@usc.edu.
BT - Health care management science
C5 - Financing & Sustainability
CP - 1
CY - Netherlands
DO - 10.1007/s10729-016-9383-1
IS - 1
JF - Health care management science
M1 - Journal Article
N2 - Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.
PP - Netherlands
PY - 2018
SN - 1386-9620; 1386-9620
SP - 131
EP - 143
EP - 
T1 - An agent-based simulation model of patient choice of health care providers in accountable care organizations
T2 - Health care management science
TI - An agent-based simulation model of patient choice of health care providers in accountable care organizations
U1 - Financing & Sustainability
U2 - 27704322
U3 - 10.1007/s10729-016-9383-1
VL - 21
VO - 1386-9620; 1386-9620
Y1 - 2018
Y2 - Mar
ER -