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Structuring Incentives Within Organizations: The Case of Accountable Care Organizations

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  • Brigham Frandsen
  • James B. Rebitzer

Abstract

Accountable Care Organizations (ACOs) are new organizations created by the Affordable Care Act to encourage more efficient, integrated care delivery. To promote efficiency, ACOs sign contracts under which they keep a fraction of the savings from keeping costs below target provided they also maintain quality levels. To promote integration and facilitate measurement, ACOs are required to have at least 5,000 enrollees and so must coordinate across many providers. We calibrate a model of optimal ACO incentives using proprietary performance measures from a large insurer. Our key finding is that free-riding is a severe problem and causes optimal incentive payments to exceed cost savings unless ACOs simultaneously achieve extremely large efficiency gains. This implies that successful ACOs will likely rely on motivational strategies that amplify the effects of under-powered incentives. These motivational strategies raise important questions about the limits of ACOs as a policy for promoting more efficient, integrated care.

Suggested Citation

  • Brigham Frandsen & James B. Rebitzer, 2014. "Structuring Incentives Within Organizations: The Case of Accountable Care Organizations," NBER Working Papers 20034, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:20034
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    References listed on IDEAS

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    Cited by:

    1. Leila Agha & Keith Marzilli Ericson & Kimberley H. Geissler & James B. Rebitzer, 2022. "Team Relationships and Performance: Evidence from Healthcare Referral Networks," Management Science, INFORMS, vol. 68(5), pages 3735-3754, May.
    2. David G. Lugo‐Palacios & Jonathan M. Clarke & Søren Rud Kristensen, 2023. "Back to basics: A mediation analysis approach to addressing the fundamental questions of integrated care evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 32(9), pages 2080-2097, September.
    3. Liang, Li-Lin & Tussing, A Dale & Huang, Nicole & Tsai, Shu-Ling, 2021. "Incentives for physician teams: Effectiveness of performance feedback and payment distribution methods," Health Policy, Elsevier, vol. 125(10), pages 1377-1384.
    4. Agha, Leila & Frandsen, Brigham & Rebitzer, James B., 2019. "Fragmented division of labor and healthcare costs: Evidence from moves across regions," Journal of Public Economics, Elsevier, vol. 169(C), pages 144-159.
    5. Leila Agha & Keith Marzilli Ericson & Kimberley H. Geissler & James B. Rebitzer, 2018. "Team Formation and Performance: Evidence from Healthcare Referral Networks," NBER Working Papers 24338, National Bureau of Economic Research, Inc.

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    More about this item

    JEL classification:

    • D23 - Microeconomics - - Production and Organizations - - - Organizational Behavior; Transaction Costs; Property Rights
    • D86 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Economics of Contract Law
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • L14 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Transactional Relationships; Contracts and Reputation
    • L24 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Contracting Out; Joint Ventures
    • M5 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Personnel Economics

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