Advisor(s)
Nancy Borkowski
Committee Member(s)
Allyson Hall
Bisakha Sen
Nathan Carroll
School
School of Health Professions
Document Type
Dissertation
Department (new version)
Health Professions
Date of Award
9-12-2025
Degree Name by School
Executive Doctor of Science (DSc) School of Health Professions
Abstract
Medicare 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.
ProQuest ID
Recommended Citation
Bujnowski, Aaron Mark, "Financial Outcomes In Value-Based Care: A Comparative Claims-Based Study Of Medicare Advantage Patients In Investor-Backed Primary Care Practices Pre/Post Investment" (2025). All ETDs from UAB. 7359.
https://digitalcommons.library.uab.edu/etd-collection/7359
