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Financial Outcomes in Value-Based Care: A Comparative Claims-Based Study of Medicare Advantage Patients in Investor-Backed Primary Care Practices Pre/Post Investment
Financial Outcomes in Value-Based Care: A Comparative Claims-Based Study of Medicare Advantage Patients in Investor-Backed Primary Care Practices Pre/Post Investment
상세정보
- 자료유형
- 학위논문 서양
- 최종처리일시
- 20260202104703
- ISBN
- 9798293829361
- DDC
- 614
- 서명/저자
- Financial Outcomes in Value-Based Care: A Comparative Claims-Based Study of Medicare Advantage Patients in Investor-Backed Primary Care Practices Pre/Post Investment
- 발행사항
- [Sl] : The University of Alabama at Birmingham, 2025
- 발행사항
- Ann Arbor : ProQuest Dissertations & Theses, 2025
- 형태사항
- 144 p
- 주기사항
- Source: Dissertations Abstracts International, Volume: 87-03, Section: B.
- 주기사항
- Advisor: Borkowski, Nancy M.
- 학위논문주기
- Thesis (D.Sc.)--The University of Alabama at Birmingham, 2025.
- 초록/해제
- 요약Medicare Advantage (MA) plans are value-based care (VBC) models aimed at improving cost and quality through prevention to counter the traditional fee-for-service (FFS) Medicare care model, which disincentivizes preventive care and risks misuse and overutilization. Some primary care practices purporting VBC capabilities have attracted private capital investors, yet whether external investment improves cost outcomes has not yet been definitively established.This dissertation examines whether investor-backed primary care organizations participating in MA demonstrate statistically significant reductions in per-patient, per-year claims costs after investment for seven ambulatory care-sensitive conditions. The study applies two-way fixed-effects regression models to a sample of 98,014 patient-year records spanning 2018 to 2024, controlling for patient demographics (age and gender), health status (Charlson Comorbidity Index), payer type, state variation, PCP practice effects and time effects. Three models were estimated: Model 1 assessed average pre- versus post-investment cost differences; Model 2 isolated the investment year effect; and Model 3 disaggregated year-specific effects from four years pre-investment to four years post-investment.Findings reveal that, although Model 1 suggests a statistically significant reduction in costs following investment, later models indicate that the cost trajectory was already declining prior to investment and did not accelerate afterward. Model 2 detected a temporary, statistically significant cost increase during the year of investment. Model 3's event-study design confirmed that cost reductions predated investor involvement, and post-investment changes were statistically indistinguishable from the continuing trend.The results suggest that investors effectively selected high-performing practices already engaged in cost-reduction strategies rather than driving new cost efficiencies. Framed within Dynamic Capabilities Theory (DCT), the study posits that investors capitalized on pre-existing organizational competencies rather than instigating cost transformation themselves.These findings have important implications for investors, policymakers, and primary care providers. Investor due diligence appears adept at identifying high performing or high potential VBC practices, and subsequent efforts to expand and professionalize the practice occur without disrupting existing value-based care strategies. Contrary to common concerns, external capital infusion did not increase costs. Future research should examine whether these trends persist in broader clinical outcomes and whether similar patterns hold across different investor types and payment models.
- 일반주제명
- Public health
- 키워드
- Claims analysis
- 키워드
- Private equity
- 키워드
- Value-based care
- 기타저자
- The University of Alabama at Birmingham Health Professions
- 기본자료저록
- Dissertations Abstracts International. 87-03B.
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■00520260202104703
■006m o d
■007cr#unu||||||||
■020 ▼a9798293829361
■035 ▼a(MiAaPQ)AAI32116416
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a614
■1001 ▼aBujnowski, Aaron Mark.
■24510▼aFinancial Outcomes in Value-Based Care: A Comparative Claims-Based Study of Medicare Advantage Patients in Investor-Backed Primary Care Practices Pre/Post Investment
■260 ▼a[Sl]▼bThe University of Alabama at Birmingham▼c2025
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2025
■300 ▼a144 p
■500 ▼aSource: Dissertations Abstracts International, Volume: 87-03, Section: B.
■500 ▼aAdvisor: Borkowski, Nancy M.
■5021 ▼aThesis (D.Sc.)--The University of Alabama at Birmingham, 2025.
■520 ▼aMedicare Advantage (MA) plans are value-based care (VBC) models aimed at improving cost and quality through prevention to counter the traditional fee-for-service (FFS) Medicare care model, which disincentivizes preventive care and risks misuse and overutilization. Some primary care practices purporting VBC capabilities have attracted private capital investors, yet whether external investment improves cost outcomes has not yet been definitively established.This dissertation examines whether investor-backed primary care organizations participating in MA demonstrate statistically significant reductions in per-patient, per-year claims costs after investment for seven ambulatory care-sensitive conditions. The study applies two-way fixed-effects regression models to a sample of 98,014 patient-year records spanning 2018 to 2024, controlling for patient demographics (age and gender), health status (Charlson Comorbidity Index), payer type, state variation, PCP practice effects and time effects. Three models were estimated: Model 1 assessed average pre- versus post-investment cost differences; Model 2 isolated the investment year effect; and Model 3 disaggregated year-specific effects from four years pre-investment to four years post-investment.Findings reveal that, although Model 1 suggests a statistically significant reduction in costs following investment, later models indicate that the cost trajectory was already declining prior to investment and did not accelerate afterward. Model 2 detected a temporary, statistically significant cost increase during the year of investment. Model 3's event-study design confirmed that cost reductions predated investor involvement, and post-investment changes were statistically indistinguishable from the continuing trend.The results suggest that investors effectively selected high-performing practices already engaged in cost-reduction strategies rather than driving new cost efficiencies. Framed within Dynamic Capabilities Theory (DCT), the study posits that investors capitalized on pre-existing organizational competencies rather than instigating cost transformation themselves.These findings have important implications for investors, policymakers, and primary care providers. Investor due diligence appears adept at identifying high performing or high potential VBC practices, and subsequent efforts to expand and professionalize the practice occur without disrupting existing value-based care strategies. Contrary to common concerns, external capital infusion did not increase costs. Future research should examine whether these trends persist in broader clinical outcomes and whether similar patterns hold across different investor types and payment models.
■590 ▼aSchool code: 0005.
■650 4▼aPublic health
■653 ▼aClaims analysis
■653 ▼aDynamic capabilities
■653 ▼aFinancial outcomes
■653 ▼aMedicare Advantage
■653 ▼aPrivate equity
■653 ▼aValue-based care
■690 ▼a0769
■690 ▼a0573
■690 ▼a0310
■71020▼aThe University of Alabama at Birmingham▼bHealth Professions.
■7730 ▼tDissertations Abstracts International▼g87-03B.
■790 ▼a0005
■791 ▼aD.Sc.
■792 ▼a2025
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17358441▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
