An Empirical Assessment of High-Performing Medical Groups: Results from a National Study

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performingmedical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

[1]  M. Alexander To Err is Human. , 2006, Journal of infusion nursing : the official publication of the Infusion Nurses Society.

[2]  L. Jerrold The corporate practice of medicine , 2004 .

[3]  James C. Robinson,et al.  What are the facilitators and barriers in physician organizations' use of care management processes? , 2004, Joint Commission journal on quality and safety.

[4]  P. Basch Quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[5]  James C. Robinson,et al.  How different is California? A comparison of U.S. physician organizations. , 2003, Health affairs.

[6]  Jennifer A. Chatman,et al.  Leading by Leveraging Culture , 2003 .

[7]  Martin Marshall,et al.  The quantitative measurement of organizational culture in health care: a review of the available instruments. , 2003, Health services research.

[8]  D. Berwick Disseminating innovations in health care. , 2003, JAMA.

[9]  Nancy E Adler,et al.  Community preventive services. Do we know what we need to know to improve health and reduce disparities? , 2003, American journal of preventive medicine.

[10]  D. Blumenthal,et al.  A research agenda for bridging the 'quality chasm.'. , 2003, Health affairs.

[11]  David Wennberg,et al.  The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care , 2003, Annals of Internal Medicine.

[12]  David Wennberg,et al.  The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care , 2003, Annals of Internal Medicine.

[13]  James C. Robinson,et al.  External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. , 2003, JAMA.

[14]  S Cretin,et al.  Quality collaboratives: lessons from research , 2002, Quality & safety in health care.

[15]  James C. Robinson,et al.  As good as it gets? Chronic care management in nine leading US physician organisations , 2002, BMJ : British Medical Journal.

[16]  Vic Hasselblad,et al.  Interventions used in disease management programmes for patients with chronic illnesswhich ones work? Meta-analysis of published reports , 2002, BMJ : British Medical Journal.

[17]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness: the chronic care model, Part 2. , 2002, JAMA.

[18]  Robert Aseltine,et al.  Evolving dissatisfaction among primary care physicians. , 2002, The American journal of managed care.

[19]  D. Gans,et al.  A comparison of the performance of hospital- and physician-owned medical group practices. , 2002, The Journal of ambulatory care management.

[20]  John H Wasson,et al.  Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. , 2002, The Joint Commission journal on quality improvement.

[21]  Thomas Bodenheimer,et al.  A primary care home for Americans: putting the house in order. , 2002, JAMA.

[22]  Anoshua Chaudhuri,et al.  The impact of financial incentives on physician productivity in medical groups. , 2002, Health services research.

[23]  Robert Friedman,et al.  Effects of a computer-based, telephone-counseling system on physical activity. , 2002, American journal of preventive medicine.

[24]  David Lansky,et al.  Improving quality through public disclosure of performance information. , 2002, Health affairs.

[25]  M. Rosenthal,et al.  Transmission of financial incentives to physicians by intermediary organizations in California. , 2002, Health affairs.

[26]  Margaret Maglione,et al.  Interventions That Increase Use of Adult Immunization and Cancer Screening Services , 2002, Annals of Internal Medicine.

[27]  Paul Slovic,et al.  Strategies for reporting health plan performance information to consumers: evidence from controlled studies. , 2002, Health services research.

[28]  N. Berkman,et al.  The Impact of a CAHPS Report on Employee Knowledge, Beliefs, and Decisions , 2002, Medical care research and review : MCRR.

[29]  Jeffrey A. Alexander,et al.  Measuring Comparative Hospital Performance , 2002, Journal of healthcare management / American College of Healthcare Executives.

[30]  R. Grol Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. , 2001, JAMA.

[31]  A. Stewart,et al.  Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes , 2001, Medical care.

[32]  Brian T. Austin,et al.  Improving chronic illness care: translating evidence into action. , 2001, Health affairs.

[33]  M Hørder,et al.  Randomised controlled trial of structured personal care of type 2 diabetes mellitus , 2001, BMJ : British Medical Journal.

[34]  W. Assendelft,et al.  Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. , 2001, Diabetes care.

[35]  C. McDonald,et al.  A computerized reminder system to increase the use of preventive care for hospitalized patients. , 2001, The New England journal of medicine.

[36]  D. Blumenthal,et al.  Personal, Organizational, and Market Level Influences on Physicians’ Practice Patterns: Results of a National Survey of Primary Care Physicians , 2001, Medical care.

[37]  Jeremy M. Grimshaw,et al.  Changing Provider Behavior: An Overview of Systematic Reviews of Interventions , 2001, Medical care.

[38]  James C. Robinson,et al.  Theory and practice in the design of physician payment incentives. , 2001, The Milbank quarterly.

[39]  M. Chassin,et al.  Improving quality, minimizing error: making it happen. , 2001, Health affairs.

[40]  J. Oliveira,et al.  The balanced scorecard: an integrative approach to performance evaluation. , 2001, Healthcare financial management : journal of the Healthcare Financial Management Association.

[41]  S. Norris,et al.  Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. , 2001, Diabetes care.

[42]  G R Baker,et al.  Creating a balanced scorecard for a hospital system. , 2001, Journal of health care finance.

[43]  A D Oxman,et al.  Evidence-based emergency medicine/systematic review abstract. Continuing education meetings and workshops: effects on professional practice and health care outcomes. , 2009, Annals of emergency medicine.

[44]  J. Ruiz Moreno [Organizational learning]. , 2001, Revista de enfermeria.

[45]  W G Henderson,et al.  Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. , 2000, JAMA.

[46]  J. Kralewski,et al.  The effects of medical group practice and physician payment methods on costs of care. , 2000, Health services research.

[47]  Stephen M. Shortell,et al.  Remaking Health Care in America: The Evolution of Organized Delivery Systems , 2000 .

[48]  W. Scott,et al.  Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care , 2000 .

[49]  P. Briss,et al.  Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults. Task Force on Community Preventive Services. , 1999, American journal of preventive medicine.

[50]  M. Cabana,et al.  Why don't physicians follow clinical practice guidelines? A framework for improvement. , 1999, JAMA.

[51]  K. Sullivan Managed care plan performance since 1980: another look at 2 literature reviews. , 1999, American journal of public health.

[52]  J. Kralewski,et al.  The effects of medical group practice organizational factors on physicians' use of resources. , 1999, Journal of healthcare management / American College of Healthcare Executives.

[53]  D. Sulmasy,et al.  Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction. , 1999, Health services research.

[54]  J S Zinn,et al.  Resource dependence and institutional elements in nursing home TQM adoption. , 1998, Health services research.

[55]  A. Flood,et al.  How do HMOs achieve savings? The effectiveness of one organization's strategies. , 1998, Health services research.

[56]  J. Newhouse,et al.  Econometrics in outcomes research: the use of instrumental variables. , 1998, Annual review of public health.

[57]  D. Cook,et al.  Evidence-based disease management. , 1997, JAMA.

[58]  J. Hadley,et al.  Effects of HMO market penetration on physicians' work effort and satisfaction. , 1997, Health affairs.

[59]  L. Aiken,et al.  Studying outcomes of organizational change in health services. , 1997, Medical care.

[60]  Michael H. McGivern,et al.  Determinants of organizational performance , 1997 .

[61]  M. Russo,et al.  A Resource-Based Perspective On Corporate Environmental Performance And Profitability , 1997 .

[62]  J. Eisenberg,et al.  Changing physicians' practices. , 1993, Tobacco control.

[63]  Brian T. Austin,et al.  Organizing care for patients with chronic illness. , 1996, The Milbank quarterly.

[64]  T. Schacker,et al.  Clinical and Epidemiologic Features of Primary HIV Infection , 1996, Annals of Internal Medicine.

[65]  J J Mohr,et al.  Improving health care, Part 1: The clinical value compass. , 1996, The Joint Commission journal on quality improvement.

[66]  R. Kaplan,et al.  The Balanced Scorecard: Translating Strategy into Action , 1996 .

[67]  P. Veazie,et al.  The effects of capitation payment on the organizational structure of medical group practices. , 1996, The Journal of ambulatory care management.

[68]  R. Thompson,et al.  Primary and secondary prevention services in clinical practice. Twenty years' experience in development, implementation, and evaluation. , 1995, JAMA.

[69]  S. Ornstein,et al.  Implementation and evaluation of a computer-based preventive services system. , 1995, Family medicine.

[70]  Paul J. Gertler,et al.  Moral Hazard and Risk Spreading in Partnerships , 1995 .

[71]  E. O'Connor,et al.  Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. , 1995, Health services research.

[72]  A. Flood,et al.  Through the lenses of organizational sociology: the role of organizational theory and research in conceptualizing and examining our health care system. , 1995, Journal of health and social behavior.

[73]  Ann Barry Flood,et al.  The Impact of Organizational and Managerial Factors on the Quality of Care in Health Care Organizations , 1994, Medical care review.

[74]  Robert H. Miller,et al.  Managed care plan performance since 1980. A literature analysis. , 1994, JAMA.

[75]  R. T. Beaty,et al.  The competitive challenge , 1993 .

[76]  D. Garvin Building a learning organization. , 1993, Harvard business review.

[77]  S. Ornstein,et al.  The effect of routine use of computer-generated preventive reminders in a clinical practice. , 1993, American journal of preventive medicine.

[78]  R. Kaplan,et al.  The balanced scorecard--measures that drive performance. , 2015, Harvard business review.

[79]  John Mitchell,et al.  Curing Health Care. New Strategies for Quality Improvement , 1992 .

[80]  Kathleen M. Carley Organizational Learning and Personnel Turnover , 1992 .

[81]  Raymond F. Zammuto,et al.  Quantitative and qualitative studies of organizational culture , 1991 .

[82]  P. Rust,et al.  Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. , 1991, The Journal of family practice.

[83]  E H Wagner,et al.  Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling. , 1991, Journal of consulting and clinical psychology.

[84]  D. Denison,et al.  Corporate Culture and Organizational Effectiveness. , 1991 .

[85]  R. Thompson,et al.  Revisions in the risk‐based breast cancer screening program at group health cooperative , 1990, Cancer.

[86]  Mark V. Pauly,et al.  Compensation and Productive Efficiency in Partnerships: Evidence from Medical Groups Practice , 1990, Journal of Political Economy.

[87]  J. Alexander,et al.  A resource-dependence model of hospital contract management. , 1989, Health services research.

[88]  D. Rubin Multiple imputation for nonresponse in surveys , 1989 .

[89]  J. Samet,et al.  Doctors' decisions and the cost of medical care: By John M. Eisenberg. Health Administration Press, Ann Arbor, Mich., 1986. 190 pp. No price given , 1987 .

[90]  Ann Barry Flood,et al.  Hospital structure and performance , 1987 .

[91]  S M Shortell,et al.  Effects of competition, regulation, and corporatization on hospital-physician relationships. , 1986, Journal of health and social behavior.

[92]  F. Wolinsky,et al.  The organization of medical practice and the practice of medicine , 1985 .

[93]  M. Hannan,et al.  Structural Inertia and Organizational Change , 1984 .

[94]  Msmw The social transformation of american medicine. , 1983, The Western journal of medicine.

[95]  S M Shortell,et al.  A theory of organizational response to regulation: the case of hospitals. , 1983, Academy of management review. Academy of Management.

[96]  Richard L. Daft,et al.  Organization Theory and Design , 1983 .

[97]  O. Williamson The Economics of Organization: The Transaction Cost Approach , 1981, American Journal of Sociology.

[98]  Howard E. Aldrich,et al.  Organizations and Environments , 1979 .

[99]  J. Pfeffer,et al.  The External Control of Organizations. , 1978 .

[100]  D. Rubin INFERENCE AND MISSING DATA , 1975 .

[101]  Rosemary Stevens,et al.  American Medicine and the Public Interest , 1973, Medical History.

[102]  Milton I. Roemer,et al.  Professional Dominance: The Social Structure of Medical Care , 1972 .

[103]  Eliot Freidson,et al.  Professional Dominance: The Social Structure of Medical Care , 1971 .

[104]  E. Freidson Claims Examined. (Book Reviews: Profession of Medicine. A Study of the Sociology of Applied Knowledge) , 1970 .

[105]  A. B. Ford,et al.  Profession of Medicine: A Study of the Sociology of Applied Knowledge , 1970 .

[106]  P. Lawrence,et al.  Differentiation and Integration in Complex Organizations , 1967 .

[107]  James D. Thompson Organizations in Action , 1967 .

[108]  Sol Levine,et al.  Exchange as a Conceptual Framework for the Study of Interorganizational Relationships , 1961 .

[109]  G. Labecki Improving care to patients. , 1956, Nursing outlook.