Title: Infrastructural mechanisms leading toward pro-accountable care organisation orientation: a survey of hospital managers

Authors: Thomas T.H. Wan; Maysoun Dimachkie Masri; Judith Ortiz

Addresses: College of Health and Public Affairs, University of Central Florida, P.O. Box 163680, Orlando, FL 32826-3680, USA ' Department of Health Management and Informatics, College of Health and Public Affairs, University of Central Florida, P.O. Box 163680, Orlando, FL 32826-3680, USA ' College of Health and Public Affairs, University of Central Florida, P.O. Box 163680, Orlando, FL 32826-3680, USA

Abstract: Organisations across the country are transforming the way they deliver care, in ways similar to the accountable care organisation (ACO) model supported by Medicare. ACOs modalities are varying in size, type, and financing structure. Little is known about how specific infrastructural mechanisms influence hospital managers' pro-ACO orientation. Using an electronic-survey of hospital managers, this study explores how pro-ACO orientation, as a latent construct, is captured from the perceptions of hospital managers; and identify infrastructural mechanisms leading to the formation of pro-ACO orientation. Of the total hospital respondents, 58% are moving toward the establishment of ACOs; 56% are planning to join in the next two years; 48% are considering joining ACOs; while 25% had already participated in ACOs during 2012. Urban hospitals are more likely than rural hospitals to be engaged in ACO development. The health provider network size is one of the strongest indicators in predicting pro-ACO orientation.

Keywords: accountable care organisations; ACO development; pro-ACO orientation; infrastructure mechanisms; healthcare networks; hospital affiliation; rural health clinics; contextual influences; hospital managers; healthcare management.

DOI: 10.1504/IJPP.2014.063081

International Journal of Public Policy, 2014 Vol.10 No.4/5, pp.243 - 256

Received: 28 Feb 2013
Accepted: 08 Jun 2013
Published online: 19 Jul 2014 *

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