Document Type

Article

Original Publication Date

2016

Journal/Book/Conference Title

Medical Care Research and Review

Volume

73

Issue

6

First Page

649

Last Page

659

DOI of Original Publication

10.1177/1077558716640411

Comments

Originally published at http://doi.org/10.1177/1077558716640411.

Date of Submission

January 2017

Abstract

Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information impactedness. Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development.

Rights

© The Author(s) 2016

Is Part Of

VCU Health Administration Publications

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