Healthcare providers’ responses to healthcare delivery reform: evaluating the effects of Medicare shared savings program on healthcare providers

Facing the escalating cost and unsatisfying quality of care, the Accountable Care Organization model was designed to as a remedy for the fragmented U.S. healthcare system and CMS established the Medicare Shared Savings Program (MSSP) as an alternative payment model. However, little evidence exists on the extent to which MSSP changes how participating providers deliver care services. Thus, I examined MSSP effects on primary care physicians’ (PCP) provision of preventive care, hospital financial sustainability, and nursing homes’ (NHs) practice.

The first study estimates how MSSP participation affect PCP preventive service delivery. Results suggest that PCPs who participated in MSSP had an increase in the likelihood and the volume of services for most preventive services in MSSP quality metrics except cancer screening. The second study assesses the impact of hospitals’ participation in MSSP on their financial performance. I found that MSSP participation was associated with small increases in net patient revenue and Medicare revenue share. No significant effects were found on outpatient and inpatient revenue, operating margin, and inpatient revenue share. The third study examined the potential influence of MSSP-affiliation on NH staffing level and deficiency citations. Results suggest that MSSP participation is related to improved staffing levels but a slight increase of total counts of deficiency citation.

This dissertation offers novel evidence on how MSSP may affect healthcare providers by using a mixture of causal inference models; and it would assist policymakers in understanding healthcare providers’ responses to policy reforms and refining future program design.