Moving Organizational Culture from Volume to Value: A Qualitative Analysis of Private Sector Accountable Care Organization Development

Health Serv Res. 2018 Dec;53(6):4767-4788. doi: 10.1111/1475-6773.13012. Epub 2018 Jul 25.

Abstract

Objective: The concept of shifting from volume (i.e., billing for as many patients and services as possible) to value (i.e., reducing costs while improving quality) has been a key underpinning of the development of accountable care organizations (ACOs), yet the cultural change necessary to make this shift has been previously unexplored.

Data sources/study setting: Primary data collected through site visits to four private sector ACOs.

Study design: Cross-sectional, semi-structured interview study with analysis done at the ACO level to learn about ACO development.

Data collection: One hundred and forty-eight interviews recorded and transcribed verbatim followed by rigorous qualitative analysis using a grounded theory approach.

Principal findings: The importance of shifting organizational culture from volume to value was emphasized across sites and interviewees, particularly when defining an ACO; describing the shift in organizational focus to value; and discussing how to create value by emphasizing quality over volume. Value was viewed as more than cost-benefit, but rather encapsulated a paradigmatic cultural change in the way care is provided.

Conclusions: We found that moving from volume to value is central to the culture change required of an ACO. Our findings can inform future efforts that aim to create a more effective value-based health care system.

Keywords: Accountable care organizations; health reform; managed care organizations; population health management; qualitative; value-based care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accountable Care Organizations / organization & administration*
  • Cross-Sectional Studies
  • Grounded Theory
  • Health Care Reform
  • Humans
  • Interviews as Topic
  • Medicare
  • Organizational Culture*
  • Private Sector*
  • Qualitative Research
  • Quality Improvement*
  • United States