The health care system in the United States largely consists of independent physicians, hospitals, and other providers. While some providers are moving to consolidate into large, integrated systems, many providers are not interested in this model—particularly after many such large systems failed in the 1990s. As a result, efforts to better coordinate or integrate patient care will largely depend on the ability of providers coordinating across independent organizations, such as private practice physicians coordinating with local hospitals and specialty physicians. This kind of partnership, cooperation, and coordination across independent physicians is both new and very challenging. This work seeks to understand the dynamics of partnerships between independent provider organizations, points of tension, and how partnerships successfully overcome them, as well as factors contributing to dissolution or stability of these partnerships.
Researchers at The Dartmouth Institute are using a mix of data to understand accountable care organization (ACO) partnerships. We use quantitative survey data from the National Survey of ACOs (NSACO), a survey conducted by Dartmouth Institute researchers that collects comprehensive data on ACO characteristics and activities. To understand the dynamics of partnerships, we are using qualitative data from 66 ACOs. We collect both semi-structured interview and observational data and conduct on-going, longitudinal site visits at a sub-set of 5 ACOs.