Xi Zhu, PhD

Phone: 319.384.3829
Email: xi-zhu@uiowa.edu

Health Management and Policy
University of Iowa
IA


Publications - (11)

  • Accountable Care Organizations in Rural America
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2013
    Reports that Medicare Accountable Care Organizations (ACOs) currently operate in 16.7% of all U.S. non-metropolitan counties.
  • Characteristics of Rural Accountable Care Organizations (ACOs) - A Survey of Medicare ACOs with Rural Presence
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 05/2015

    In this policy brief, we present the findings of a survey of 27 rural ACOs focusing on characteristics important to their formation and operation. We find that a majority of responding ACOs were formed from pre-existing integrated delivery systems and had physician and hospital participants with prior risk-sharing and quality-based payment experience. In addition, physician groups played a leading role in the formation and management of the ACOs.

  • Developmental Strategies and Challenges for Rural Accountable Care Organizations
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 02/2015

    This Policy Brief shares insights into initial strategic decisions and challenges of four Accountable Care Organizations (ACOs) with a rural presence, one from each census region (West, Midwest, Northeast, and South). Semi-structured on-site interviews were conducted with ACO leaders and key stakeholder group representatives (e.g., board members, physicians). The four ACOs were formed as a step toward a value-driven rural delivery system, recognizing that ACO participation may not have a short term return on investment. Common value-enhancing strategies included care management, post-acute care redesign, medication management, and end-of-life care planning. The four ACOs also emphasized the importance of access to data for population health management, care management, and provider participation. While several challenges need to be addressed, these insights can inform development of other rural ACOs.

  • Facilitating the Formation of Accountable Care Organizations in Rural Areas
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 07/2014

    Presents characteristics contributing to the formation of four accountable care organizations (ACOs) that serve rural Medicare beneficiaries, one each of the four census regions (West, Midwest, Northeast, and South). Semi-structured interviews were conducted on-site with ACO leaders and representatives of key stakeholder groups (e.g., board members, physicians, information technology managers). Four organizational characteristics emerged as influential in the formation of these ACOs. First is previous organizational integration experience, which includes physician-hospital organizations, independent practice associations and mergers. Second is experience in risk-sharing arrangements, which includes participation in the Medicare Advantage program and insurance plan ownership. Third are information technologies, especially shared electronic health records, which enable several ACO capabilities. And fourth is developing partnerships with health and human services organizations in local and regional communities. These findings can help rural providers interested in forming or participating in an ACO assess the status and potential gaps of their core structures and capabilities.

  • Financial Performance of Rural Medicare ACOs
    RUPRI Center for Rural Health Policy Analysis
    Date: 08/2016
    Assesses the financial performances of rural accountable care organizations based on different levels of rural presence.
  • From Health Care Volume to Health Care Value - Success Strategies for Rural Health Care Providers
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014
    Examines strategies that rural healthcare providers can use to improve healthcare quality for patients.
  • Medicare Accountable Care Organizations: Beneficiary Assignment Update
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 06/2016
    This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services Accountable Care Organization regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Understanding ACO beneficiary assignment policies is dire in managing ACO providers and beneficiaries.
  • Medicare Accountable Care Organizations: Program Eligibility, Beneficiary Assignment, and Quality Measures
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2014

    Discusses the Medicare Shared Savings Program (MSSP) eligibility, participation requirements, and quality measures relative to Accountable Care Organization (ACO) formation.

    Recommendations: Organizations considering participating in the MSSP (Medicare ACO program) should carefully review program eligibility requirements and the beneficiary assignment process. Due to beneficiary assignment based on the greater of allowed Medicare charges, new Medicare ACOs may discover fewer assigned beneficiaries than anticipated. Potential shared savings will be reduced by suboptimal quality Therefore, new Medicare ACOs must provide excellent care in 33 outpatient clinical quality and patient satisfaction measures to a void shared savings reduction.

  • Medicare Accountable Care Organizations: Quality Performance by Geographic Categories
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 11/2016
    This brief provides an analysis of the differences in ACO performance on the quality measures among the Medicare Shared Saving Program (MSSP) ACOs with varying levels of rural presence. Findings suggest that ACOs with a significant rural presence have performed as well as, if not better than, urban ACOs in delivering quality care.
  • A Rural Taxonomy of Population and Health-Resource Characteristics
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 04/2015

    This policy brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics; and discusses how this classification tool can be utilized by policy makers and rural communities. Using the most current data from multiple sources, we applied the cluster analysis to classify 10 distinct types of rural places based on characteristics related to both demand (population) and supply (health resources) sides of the health services market. In descending order, the most significant dimension in our classification was facility resources, followed by provider resources, economic resources, and age distribution. Each type of rural places was distinct from other types of places based on one or two defining dimensions.

  • Trends in Hospital Network Participation and System Affiliation, 2007-2012
    Policy Brief
    RUPRI Center for Rural Health Policy Analysis
    Date: 2014

    Network participation and system affiliation represent two viable ways for hospitals to build and/or access necessary capacities to engage in the transformation to an integrated, patient-centered, pay-for-value model of care delivery. This policy brief tracks trends in network participation and system affiliation among U.S. general community hospitals from 2007 to 2012. Network participation increased in larger hospitals, non-government not-for-profit hospitals, and metropolitan hospitals. System affiliation generally increased in hospitals of all sizes and types. However, there are notably higher percentages of system affiliation among midsized and large hospitals, investor-owned hospitals, and metropolitan hospitals compared to their counterparts.