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The purpose of this paper is to identify the primary executive leadership skills required to promote the effectiveness of Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) and to create a new substantive theory describing these skills. The author identifies that MSSP ACO is a relatively new value-based care delivery (VBCD) structure in the USA that links clinicians’ compensation to their clinical outcomes. The research question concerns what primary executive leadership skills are essential in the VBCD era.

This single, embedded, exploratory case study is based on interviews, a focus group discussion and archival record data of MSSP ACO executives in the Northeast, Midwest, South and West of the USA.

The findings represented seven major categories or the primary executive leadership skills required to succeed in the VBCD environment. Each category or skill included five subcategories or concepts supporting the leadership skills essential for reaching VBCD goals. The categories and subcategories gave rise to a new substantive theory – the Accountable Healthcare Leadership Theory of Five Ps: promoting partnership between providers, patients and payers.

The empirical generalizability of the results was limited by its essence as a single, embedded, exploratory case study of 18 MSSP ACO executives in 4 regions of the USA. The strength of this study, however, lies in its potential for making analytic generalizations for identifying theoretically meaningful leadership skills essential for success in the VBCD era.

The author has developed and validated a new theory describing the primary executive leadership skills required to succeed in the VBCD environment.

With regard to product variety and cost competition, just-in-time (JIT) part-supply has become a critical issue in automobile assembly lines (AALs). This paper aims to investigate a multiple server scheduling problem (MSSP) encountered in the JIT part-supply process of AALs. Parts are stored in boxes and allotted from the JIT-supermarket to consumptive stations with a multiple server system. The schedule is to dispatch and sequence material boxes on each server for minimizing line-side inventory levels.

A mixed integer linear programming (MILP) model is established to formulate the proposed MSSP to pave the way for CPLEX procedure. Considering the high complexity of MSSP, a hybrid ant colony optimization (HACO) approach is developed by integrating basic ant colony optimization (ACO) with local optimizers that comprise of a fast local search and a tailored breadth-first tree search method.

Both CPLEX and HACO approach are capable of solving small-scale instances to optimality within reasonable computation time. The proposed HACO has been well enhanced with the embedded fast local search and tailored breadth-first tree search, and it performs robustly in a statistically significant manner when applied to real-world scale instances.

No stock-outs constraints and weighted line-side inventory level are considered in this paper, and the MSSP is solved satisfactorily to facilitate an efficient JIT part-supply of the AAL. In terms of the algorithm design, a tree search-based local optimizer is embedded into ACO to combine the mechanisms of ACO and problem-specific optimization.

The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population.

Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013).

Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it.

Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses.

ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population.

Using new empirical data, this study increases understanding of the extent of ACOs’ current and developing HIT capabilities to support ongoing care management.

Purpose: We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts.

Methodology/Approach: A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008–2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period.

Findings: Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of “ACO RHCs,” there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel.

Research Limitations/Implications: There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs.

Originality/Value of Paper: This chapter presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The US Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the US healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.

There are longstanding concerns about the sustainability of the US health care system. Payment reform has been seen over the last decade as a key strategy to reorienting the US health care system around value. Alternative payment models (APMs) that seek to accomplish this goal have become increasingly prevalent in the US, yet there is a perception that physicians are resistant to their use and that organizations have been slow to adopt such models. The reasons for the limited effectiveness of APM programs are multifactorial and include aspects related to the design and implementation of these programs and lack of alignment and coordination across different payers and health care sectors. Most importantly, however, is that the current organizational structures in US health care serve to dampen the direct impact of these incentives, often because health care delivery organizations face conflicting incentives themselves. Organizations filter and refine the incentives from multiple external payment contracts and develop internal incentive systems that best reflect the amalgamation of the incentives embedded across their contracts, and thus the fragmented nature of the US health care system serves to undermine efforts to transform care under value-based contracts. In addition to organizations having conflicting incentives, there also are fundamental problems with the design and implementation of APMs that hinder their acceptance among physicians and the organizations in which they work. Moreover, much remains to be learned about how organizations can best adapt to succeed under these models, and how organizational culture can be leveraged to transform care.

Prior studies have shown that physician-led hospitals have several advantages over non-physician-led hospitals. This study seeks to test whether these advantages also extend to periods of extreme disruptions such as the COVID-19 pandemic, which affect bed availability and hospital utilization.

The authors utilize a bounded Tobit estimation to identify differences in patient satisfaction rates and in-hospital utilization rates of top-rated hospitals in the United States.

Among top-rated US hospitals, those that are physician-led achieve higher patient satisfaction ratings and are more likely to have higher utilization rates.

While the COVID-19 pandemic generated greater demand for inpatient beds, physician-led hospitals improved their hospitals’ capacity utilization as compared with those led by non-physician leaders. A longitudinal study to show the change over the years and whether physician Chief Executive Officers (CEOs) are more likely to improve their hospitals’ ratings than non-physician CEOs is highly recommended.

Recruiting and retaining physicians to lead hospitals, especially during disruptions, improve hospital’s operating efficiency and enhance patient satisfaction.

The paper reviews prior research on physician leadership and adds further insights into the crisis leadership literature. The authors provide evidence based on quantitative data analysis that during the COVID-19 pandemic, physician-led top-rated US hospitals experienced an improvement in operating efficiency.

This chapter provides an overview of the role of technology and policy in shaping care plans for patients. Historically, healthcare has lagged behind other industry sectors in adopting and deploying useful technologies, and policy surrounding use is an important component of establishing a long-term strategy. This chapter evaluates the current state of technology in the clinical setting and extends the widely adopted policy-based approaches into the palliative care context.