Assessing Quality Improvement Infrastructure in the Formation of Accountable Care Organizations: A Regional Policy Analysis for the Pharmaceutical Industry

Accountable Care Organizations are developing in the United States as a result of the Patient Protection and Affordable Care Act. A study is needed to evaluate an emerging issue of ACOs, quality improvement infrastructure, and the pharmaceutical industry. The convergence of these topics has not been studied. Pharmaceutical companies are striving to educate themselves of the changing quality improvement infrastructure for strategic alignment. This paper maps out the current distribution of ACOs as well as fifteen quality improvement variables spread over four categories deemed important by health policy experts. The four categories are: Strategic Leadership, Health Information Technology, Quality Measurement, and Demonstration/Pilot Experience. The aim is to compare states with ACOs to states without ACOs. Comparisons are made through excel spreadsheets, visualizations, and a logistic regression. 121 ACOs were discovered. The results showed states with ACOs to have much more variables present, indicating a more advanced infrastructure. Differences are seen in the most prevalent categories of variables in presence of ACOs. Survey results showed 5 of 9 health policy experts in the pharmaceutical industry believe demonstration/pilot experience is the most important variable studied. Logistic regression did not show any statistically significant results of the fifteen variables in comparing states with ACOs to states without ACOs; however, health information exchanges were the closest to significant and a positive association with ACO formation is likely. Pharmaceutical companies strive to be prominent in the changing competitive and inclusive environment of healthcare delivery system and need to be active in their surveillance and approach. Drugs and devices must be marketed as improving quality with outcomes measures in order show ACOs so the most reimbursements are seen from Medicare and the Cost Savings Program. Further study is required as the quality improvement infrastructure evolves through PPACA implementation.