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The Diffusion and Performance of the Accountable Care Organization Model
Title
The Diffusion and Performance of the Accountable Care Organization Model.
Creator
Lin, Yi-ling, Wan, Thomas, Malvey, Donna, Liu, Albert Xinliang, Steen, Julie, University of Central Florida
Abstract / Description
Background: Unity in pursuit of the Triple Aim: better health, better care, and lower per capita cost, can be achieved through a well-designed health care delivery system. The accountable care organizations (ACOs) model is considered a key component of health care delivery system improvement because the model fosters better coordination of care through clinical integration and financial accountability. Within the six Centers for Medicaid (&) Medicare Services (CMS) ACO programs, the Medicare...
Show moreBackground: Unity in pursuit of the Triple Aim: better health, better care, and lower per capita cost, can be achieved through a well-designed health care delivery system. The accountable care organizations (ACOs) model is considered a key component of health care delivery system improvement because the model fosters better coordination of care through clinical integration and financial accountability. Within the six Centers for Medicaid (&) Medicare Services (CMS) ACO programs, the Medicare Shared Savings Program (MSSP) ACO has the largest size with a total of 432 ACOs formed; the service subjects of the MSSP ACO are the fee-for-service beneficiaries. Recently, academicians and researchers have been attracted to exploring ACOs' formation and performance. However, most of the early ACO research types are either descriptive or case study. Also, early researchers had limited access to ACO data sets, so they could utilize only regional and demographic factors to identify the predictors of ACO formation.Purpose: An integrative theoretical framework, Rogers' diffusion of innovation theory and Duncan's POET model, was used to examine ACO formation and performance. The first purpose of this study was to determine the relative influences of contextual variables and ACO characteristic variables on how early an ACO model was adopted. The second purpose was to examine how executives' perceptions of ACO performance and the ACO first-year performance are influenced by the contextual variables, ACO characteristic variables, and timing of the adoption of an ACO model. Methods: A cross-sectional design was formulated to gather data from a survey supplemented by secondary data with the analysis unit at the organization level. Study participants in the ACO survey included 2012, 2013, 2014, and 2015 ACO cohorts. Logistic regression was performed to examine the effects of POET and Rogers' five core characteristics in the early adoption of an ACO model (dichotomous). Additionally, multiple linear regression analysis was used to examine the effects of POET and the timing of adoption of an ACO model in the perceptions of ACO performance. ACO first-year performance dataset consisted only of ACO cohorts from 2012 through 2014. Finally, confirmatory factor analysis and structural equation modeling were conducted to examine the measurement model of the ACO first-year performance and a full latent variable model, respectively. Major Findings: A survey of ACO executives/managers between October 2015 and February 2016 was conducted. The 447 MSSP ACOs in my mailing list yielded a response rate of 13.65 % (n=61). Of the 61 MSSP ACOs, 42 (52.5%) were late adopters whose contractual agreement with CMS started in 2014 or 2015, and 36 (59.0%) were with hospital-based composition. Among ACOs that participated in my survey, their current degree of IT adoption in functionalities (62.27 vs. 52.50 points), usage levels (65.19 vs. 49.49 points), and integration levels (62.24 vs. 53.37 points) were better than their initial years. The multiple logistic regression presented that MSSP ACOs were more likely to be early adopters of a CMS if their service areas had high unemployment rates (OR=2.23; 95% CI: 1.13 - 4.39). In the multiple linear regression analysis, the executives in the early ACOs perceived their organizations as more effective than the late adopters, with 12.65 points higher in an aggregate of eight ACO quality domains (p = .005). Three hundred and seventeen MSSP ACOs, with contractual agreements with CMS before 2015, had retained their year-one performance records (the actual ACO performance with eight quality domains). The variability in the actual ACO performance was explained by the predictor variables of the study with an R-square of 15%. The actual ACO performance was likely to be improved if ACOs had more Medicare assigned beneficiaries or had the hospital-based composition. On the other hand, if ACOs' service areas were located in areas of high poverty concentration, a high unemployment rate, or a lower competitive index, their ACO performance was relatively lower than their counterparts. Implications: The findings suggest that managers should consider strategies to increase economies of scale in size and to have hospital involvement in their ACOs in order to increase effective management. Inadequate capital for information technology improvements is the biggest barrier inhibiting healthcare providers' willingness to join an ACO. Regardless of rural or urban areas, financial support is still important for those potential ACO participants who are planning to invest in necessary infrastructure. ACOs that involved hospitals also showed better performance than those ACOs without hospital involvement. This information may help health policy makers to define core principles of the best ACO model in the future. Conclusions: This study makes a unique contribution using a theoretically integrative framework with Rogers' diffusion of innovation theory coupled with Duncan's POET model to examine ACO formation and ACO performance. In the early ACO adopters, three-fifths of the ACOs had hospital involvement; and the levels of their current IT degree in functionalities, usage levels, and integration levels are higher than the late ACO adopters. This study demonstrates that contextual variables, such as unemployment rates at ACO service areas, relatively influence how early an ACO model was adopted. Executives in the early ACOs had higher perceptions of overall organizational effectiveness as compared with the late adopters. The first-year performance of 2012, 2013, and 2014 ACO cohorts is positively influenced by the size of assigned Medicare beneficiaries and hospital-based ACO and is negatively influenced by the poverty rate, unemployment rate, and market competition scores (Herfindah-Hirschman Index).
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Date Issued
2016
Identifier
CFE0006347, ucf:51576
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0006347
A RELATIONAL DIFFUSION NETWORK STUDY OF SYNCHRONOUS AND ASYNCHRONOUS INTERNET-BASED FACULTY'S PERSONAL NETWORK EXPOSURE MODELS RELATED TO DISCUSSIONS ABOUT TEACHING ONLINE
Title
A RELATIONAL DIFFUSION NETWORK STUDY OF SYNCHRONOUS AND ASYNCHRONOUS INTERNET-BASED FACULTY'S PERSONAL NETWORK EXPOSURE MODELS RELATED TO DISCUSSIONS ABOUT TEACHING ONLINE.
Creator
Pick, Dorothy, Orwig, Gary, University of Central Florida
Abstract / Description
For many faculty, teaching online represents a new instructional delivery method, requiring the development of new teaching skills. This exploratory investigation builds upon Rogers' (2003) Diffusion of Innovations theory and communication channels to describe the influence of faculty discussions on their perceptions and decisions about teaching and learning. A sequential explanatory mixed-methods research design, using both sociometric and phenomenological methodologies, guided the...
Show moreFor many faculty, teaching online represents a new instructional delivery method, requiring the development of new teaching skills. This exploratory investigation builds upon Rogers' (2003) Diffusion of Innovations theory and communication channels to describe the influence of faculty discussions on their perceptions and decisions about teaching and learning. A sequential explanatory mixed-methods research design, using both sociometric and phenomenological methodologies, guided the exploration of faculty personal network exposure models and social learning opportunities. The study utilized online survey and open-ended interview instruments for the investigation. Faculty from several colleges at the University of Central Florida voluntarily completed the survey instrument identifying with whom, how, and why they discuss teaching online, including the influence of these discussions. In-depth interviews offered internal descriptions of their personal networks. Survey results established baseline data for demographic and future comparisons and identified concerns, issues, and trends unique to synchronous and asynchronous Internet-based faculty development and support needs. Phenomenological data produced the emergent categories and themes used to investigate and explain faculty's communication channel usage and social learning experiences. Similarities between diffusion and knowledge research findings and participants reflected more conformity than anticipated. Differences in communication channel and learning style preferences and usage and faculty's 24/7 work life needs, present challenges to administrators and educators responsible for providing development and support systems.
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Date Issued
2006
Identifier
CFE0000967, ucf:46712
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0000967
THE EFFECT OF APPLYING WIKIS IN AN ENGLISH AS A FOREIGN LANGUAGE (EFL) CLASS IN TAIWAN
Title
THE EFFECT OF APPLYING WIKIS IN AN ENGLISH AS A FOREIGN LANGUAGE (EFL) CLASS IN TAIWAN.
Creator
Chen, Yu-ching, Witta, Lea, University of Central Florida
Abstract / Description
Incorporating technology into learning has brought major benefits to learners and has greatly changed higher education. Since there is limited number of experimental research investigating the effectiveness of applying wikis, this study collected experimental data to investigate its effectiveness. The purpose of the study was to examine the effectiveness of applying wikis in terms of students' learning outcomes, to investigate the changes regarding students' attitude towards language...
Show moreIncorporating technology into learning has brought major benefits to learners and has greatly changed higher education. Since there is limited number of experimental research investigating the effectiveness of applying wikis, this study collected experimental data to investigate its effectiveness. The purpose of the study was to examine the effectiveness of applying wikis in terms of students' learning outcomes, to investigate the changes regarding students' attitude towards language learning, to explore the communication channels in wikis that facilitate students' interaction in the e-learning environment as well as students' experience of using wikis. Results showed that there existed statistically significant difference between the group with and without wikis, which means the group applying wikis performed better in listening and reading abilities. When compared with the non-wiki group, the wiki group had a more favorable attitude towards the class, their English ability improvement, and cooperative learning. Moreover, the students agreed that wikis helped them complete their assignment, they felt comfortable in the wiki environment, and it was easy for them to use wikis. From the experiences of using wikis shared by the students, they provided recommendations about the interface and the edit functions in the wiki environment. Their interaction with other team members and the course material increased but they expressed that the main interaction was through face-to-face and instant message software. Finally, the wiki environment allowed students to fulfill their role duties, cooperate, negotiate, manage their contribution, and modeling from each other.
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Date Issued
2008
Identifier
CFE0002227, ucf:47919
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0002227
MYSPACE OR OURSPACE: A MEDIA SYSTEM DEPENDENCY VIEW OF MYSPACE
Title
MYSPACE OR OURSPACE: A MEDIA SYSTEM DEPENDENCY VIEW OF MYSPACE.
Creator
Schrock, Andrew, Brown, Timothy, University of Central Florida
Abstract / Description
MySpace is a type of "social networking" website where people meet, socialize, and create friendships. The way MySpace members, particularly younger individuals, interact online underscores the changing nature of mass media. Media system dependency states that individuals become reliant on media in their daily life because of fundamental human goals. This reliance, termed a dependency, leads to repeated use. Media system dependency was applied in the current study to explain how and why...
Show moreMySpace is a type of "social networking" website where people meet, socialize, and create friendships. The way MySpace members, particularly younger individuals, interact online underscores the changing nature of mass media. Media system dependency states that individuals become reliant on media in their daily life because of fundamental human goals. This reliance, termed a dependency, leads to repeated use. Media system dependency was applied in the current study to explain how and why individuals became habitual MySpace users. To attain results a survey was administered to a convenience sampling of 401 adult undergraduates at the University of Central Florida. Members reported MySpace dependency had a moderate correlation to MySpace use, and they actively used the website an average of 1.3 hours of use per day. Results indicated members use MySpace to primarily satisfy play and interaction orientation dependencies. MySpace use was found to have a correlation with number of MySpace friends. "Number of friends created" in turn had a correlation with MySpace dependency, as people returned to interact with their friends. Individual factors were also found to be a source of influence in MySpace dependency. These individual factors were demographics, psychological factors related to use of the Internet, and psychological factors related to use of MySpace. Factors related to MySpace, extroversion and self-disclosure, were positively correlated with intensity of dependency. The influence of factors related to the Internet was partly supported; computer self-efficacy was not significantly related to MySpace dependency, while computer anxiety was significantly related to MySpace dependency. Speed of connection to the Internet and available time to use the Internet were not related to MySpace dependency. Additionally, significant differences were found between genders in overall dependency, extroversion, self-disclosure, computer anxiety, and computer self-efficacy. These findings provide evidence that MySpace members were little, if at all, constrained by factors related to use of the Internet, but were attracted to the websites for similar reasons as real-life relationships. Finally, MySpace is just one of the large number of online resources that are predominantly social, such as email, message boards, and online chat. This study found that through a "technology cluster" MySpace members use these other social innovations more frequently than non-members. However, members also used significantly more non-social innovations, which may indicate that MySpace members are part of a larger technology cluster than anticipated or perhaps are in the same category of innovation adopter.
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Date Issued
2006
Identifier
CFE0001451, ucf:47057
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0001451
An Investigation of Boaters' Attitudes toward and Usage of Targeted Mobile Apps
Title
An Investigation of Boaters' Attitudes toward and Usage of Targeted Mobile Apps.
Creator
Bowerman, Kamra, Delorme, Denise, Brown, Timothy, Neuberger, Lindsay, University of Central Florida
Abstract / Description
The purpose of this study was to understand boaters' adoption and usage of smartphones and mobile apps as well as to obtain their opinion on potential features of a targeted mobile app being developed as part of a broader interdisciplinary Florida Sea Grant outreach project. Data were gathered from an online survey of a sample of 164 boaters from the surrounding Central Florida area. In contrast with previous empirical mobile app studies, many respondents reported using mobile apps for...
Show moreThe purpose of this study was to understand boaters' adoption and usage of smartphones and mobile apps as well as to obtain their opinion on potential features of a targeted mobile app being developed as part of a broader interdisciplinary Florida Sea Grant outreach project. Data were gathered from an online survey of a sample of 164 boaters from the surrounding Central Florida area. In contrast with previous empirical mobile app studies, many respondents reported using mobile apps for information-seeking versus escape gratifications. Further more than half of the respondents' age sixty-five and over indicated using smartphones and mobile apps. These findings reflected recent national trend data showing shifting gratifications and an increase in technology use among older American adults. In regards to the planned mobile app, the study's respondents had favorable reactions to its potential features and indicated an above average intent toward downloading the app.
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Date Issued
2013
Identifier
CFE0004655, ucf:49902
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004655