An Application of Propensity Score Analysis on Perceived Benefits and Barriers Associated with Participation in Accountable Care organizations

Little is known about how a majority of acute care hospitals will navigate their strategic move to adopt an innovative care delivery system, Accountable Care Organizations (ACOs). This research analyzed perceived benefits and barriers among acute hospitals including but not limited to improvements in the hospital strategic-level factors, the operational-financial factors (adoption of bundle care and bundle payment), the information technology factors, and finally the organizational network integration and market factors (physician-hospital integrations) affecting ACO participation. It is postulated that when benefits are higher than barriers perceived by hospital administrators, they are more likely to participate in ACOs. Individual and hospital factors are more influential than community/contextual factors in the willingness to adopt ACOs. The propensity score analysis is used to eliminate potential biased selection factors such as size, age, volume, payer mix, case mix, and market competition among the study hospitals. Several Likert-Scale measures of the theoretical constructs such as willingness to participate in ACOs, perceived benefits, perceived barriers, and organizational social capital are developed and validated, using structural equation modeling. Multilevel covariance structure analysis is performed to test the study hypotheses and to validate the proposed theoretical model of determinants of ACO participation in hospitals. The survey results show that the key predictors of willingness to participate are knowledge about ACO, organizational social capital, and acceptance of planned change. Overall, reasonable goodness of fit statistics show that the proposed model, developed under the integrated theoretical framework of cognitive dissonance and diffusion of innovation, is confirmed by the data.