All ETDs from UAB

Advisory Committee Chair

Nancy Borkowski

Advisory Committee Members

Nathaniel Carroll

William Opoku-Agyeman

Dean G Smith

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


Accountable Care Organizations (ACOs) are integrated groups of providers responsible for reducing cost and improving quality for a group of individuals. Medicare began using these organizations in 2012, after the passage of the Affordable Care Act (ACA), to move away from traditional fee-for-service reimbursement. This alternative payment model is the Medicare Shared Savings Program (MSSP). MSSP affords ACOs the opportunity to receive a portion of the savings they achieve if specific cost targets and quality benchmarks are met. Length of participation time in the alternative payment model may increase the ACOs’ ability to achieve savings. The analysis of MSSP savings and length of participation was framed within the context of Knowledge-Based Theory, which posits that learning how to manage within the MSSP over time may yield better results. The Centers for Medicare and Medicaid Services publishes ACO cost and performance data on for public use. The analysis utilized data from 2018 to determine if there was an association between participation time (ACO age) and medical cost savings. Hypotheses were tested using a t-test and regression analyses. Each additional year of ACO was associated with an average of $772,352.80 of gross savings (p = 0.002). iv Additionally, ACO age was correlated with achievement of a shared savings bonus as ACOs had 1.24 (p < 0.000) times the odds of achieving bonus for each additional year of participation/age. The findings suggest that ACO age is a factor that may contribute to the savings and bonuses of ACOs.



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