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Performance management and hybridization of healthcare – case of the accountable care organization

Petra Kokko (Faculty of Management and Business, Tampere University, Tampere, Finland)
Harri Laihonen (Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland)

Journal of Public Budgeting, Accounting & Financial Management

ISSN: 1096-3367

Article publication date: 8 December 2021

Issue publication date: 26 April 2022




The article seeks to explain whether and how value-based healthcare principles lead to hybridization. The public management literature has been increasingly interested in hybrid forms of governance and hybrid performance management, but empirical studies are still rare. Further, the article studies the design of performance management and accounting systems as healthcare organizations reorganize their care processes applying value-based healthcare principles.


This article first connects the theoretical discussions on value-based healthcare and performance management for hybrids. The conceptual understanding of performance management in hybrid healthcare uses a case study of a Finnish healthcare organization with documentary data and transcribed interviews with healthcare professionals from both the strategic and operative levels of healthcare.


The article illustrates and analyses how new policy-level objectives and principles of value-based healthcare led to hybridity in healthcare, manifest in mixed ownership of a particular care path and new forms of social and financial control. Further, the article provides empirical evidence of how increased hybridity necessitated new organizational modes and roles, new managerial tools for performance management and created a need to develop the capability to account and measure entire integrated care processes. Important enabling factors for the integration of care and hybrid performance management were commitment created in dialogue, voluntary-based trust and technology to generate factual shared information.

Practical implications

The study is informative for stakeholders, funders and managers of healthcare organizations, namely new knowledge for the discussion of hybrid governance in healthcare, including a critical account of the applicability and impact of a hybrid service model in healthcare management. Moreover, the article illustrates what needs to be reconsidered in performance management and accounting practices when reorganizing care processes according to the principles of value-based healthcare.


The article extends the analysis of performance management in hybrids and sheds new light on hybridization in healthcare. It also provides much-needed empirical evidence on the processes and practices of accounting and performance management after implementing a value-based healthcare strategy.



The authors want to thank for the cooperation article’s case organization and all the interviewees for their time and effort for this research. The authors also thank the research group for the support and ideas in the development and planning of the evaluation project. This research is a part of research project Performance Measurement for Hybrid Governance funded by the Academy of Finland (N:o 326525).


Kokko, P. and Laihonen, H. (2022), "Performance management and hybridization of healthcare – case of the accountable care organization", Journal of Public Budgeting, Accounting & Financial Management, Vol. 34 No. 3, pp. 411-429.



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