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

McAlearney AS, Walker DM, Hefner JL
Health Serv Res 53 4767-4788 01/01/2018


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.

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