CPPR Health Policy Seminar: Claire Senot (Tulane)

The Health Policy Working Group, a core initiative of the Health Policy Program in the Center for Public Policy Research (CPPR), is an interdisciplinary network of Tulane researchers and practitioners whose work focuses on a broad range of issues at the intersection of health and the social sciences.

Each semester, the Health Policy Working Group invites members, participants, and guest speakers to present their latest research and receive feedback from the group members. The group is organized by Murphy Core Faculty members Mary Olson, Associate Professor Economics and Director of the Health Policy Program, and Kevin Callison, Associate Professor of Health Policy and Management in the Celia Scott Weatherhead School of Public Health and Tropical Medicine. 

Professor Senot's research interests include health care operations, quality management, and organizational learning. Her work focuses on the relationships between processes and outcomes in health care delivery and the factors that moderate these relationships. She frequently incorporates findings from her research in her operations and supply chain management course.

Although Professor Senot favors econometric analyses using large databases to derive analytical results, she works closely with practitioners and always seeks to anchor her research in practice. She has done in-depth fieldwork at renowned hospitals, such as the Cleveland Clinic, which has provided the basis for her research ideas, analytical approaches, and interpretations. In her most recent work, Professor Senot uses patient-level data to reveal an all-encompassing picture of heart failure patients' health care delivery journey. Professor Senot's work has been published in prominent operations management journals and featured in practitioner-oriented publications.

Abstract:
By improving coordination between primary care, specialists, hospitals, and other care providers, Accountable Care Organizations (ACOs) have been hailed as a promising response towards fragmentation across the U.S. healthcare system. Yet no single approach has emerged in terms of how different ACOs organize and coordinate care between participating physicians. Thus, ACOs provide an excellent empirical setting for the study of care coordination due to their diversity both in terms of structure but also in terms of outcomes. In this study, we exploit this variability and draw on network theory to understand how the nature of care coordination across ACO physician referral networks is associated with cost and quality performance. Using Medicare Shared Savings Program (MSSP) ACOs, we construct physician patient-sharing networks from close to 250 million Medicare claims spanning 2014-2018, covering 567 unique ACOs and approximately 260,000 physicians. Fixed-effects regressions provide no evidence that aggregate network characteristics, such as size or fragmentation, are associated with either cost or quality outcomes. In contrast, network composition and physician positioning are related to performance. ACOs with a greater presence of primary care providers (PCPs) and stronger PCP influence achieve superior cost and quality outcomes. Surprisingly, a higher proportion of ties between ACO-affiliated PCPs and ACO-affiliated specialists is associated with worse performance on both dimensions. We extend network theory in healthcare operations by demonstrating how different structural dimensions collectively shape organizational performance in complex care delivery systems. From a managerial perspective, our findings suggest that resources should be directed toward strengthening PCP centrality and developing targeted connections to external specialists rather than simply increasing formal specialist inclusion.