Institut de Recherche et Documentation en Economie de la Santé (IRDES)
Mentor:Jonathan Skinner, Ph.D. (Geisel School of Medicine at Dartmouth College)
Co-Mentor:Carrie Colla, Ph.D. (The Dartmouth Institute for Health Policy and Clinical Practice, Geisel Medical School at Dartmouth College)
Project: Alternatives to Pure Fee-for-Services Payment Within Accountable Care Organizations and/or Patient-Centered Medical Homes
Julien Mousquès, Ph.D., is a 2015–16 French Harkness Fellow in Health Care Policy and Practice. He is currently research director at the Institut de Recherche et Documentation en Economie de la Santé (IRDES), a position he was promoted to in 2015. Prior to the promotion, he served as both a senior research fellow (2004–2014) and a junior research fellow (1999–2004) at IRDES. During the last five years, his research has primarily focused on the organizational structure of health care professionals working in primary care practices, which has attracted considerable interest from the French Department of Health and the French National Health Insurance Fund (CNAMTS) and has influenced policy decision-making. He also led a team at IRDES to evaluate a major pilot project launched on primary care medical homes involving 150 multidisciplinary teams to test new methods of payments. He has published 9 peer-reviewed journal articles, including in Health Policy, Social Science and Medicine, and Regional and Urban Economics. Mousquès holds a Ph.D. in health economics from the University of Paris-Dauphine.
In both the American and French health care systems, policies have been implemented to reinforce primary health care delivery by encouraging multi-professional group practices and/or supporting the development of new organizational forms, such as primary care teams (PCTs). Both countries have faced similar barriers to ensuring that payment structures foster care coordination and meet the needs of particular patient groups – including high-need, high-cost patients and other vulnerable groups. Two new organizational forms have emerged as alternatives to the pure fee-for-service payment models: patient-centered medical homes (PCMH) and accountable care organizations (ACOs). Mousquès aims to analyze the impact of these on efficiency of healthcare delivery. Mousquès will explore the technical efficiency (i.e. maximum output from the minimum quantity of inputs), and the balance of care and services (e.g. specialist vs. primary care physician’s) delivered and used by patients. The research hypothesis is that a mixed payment system which combines prospective payments and/or saving models, as opposed to fee-for-service, is more efficient and effective in stimulating teamwork. The research framework and design combines three phases. First, the explanatory phase (i.e. the who and what), will analyze data from the National Survey of Accountable Care Organizations (NSACO) to categorize ACOs and identify risk sharing and internal savings. The second depth phase (i.e. the how), includes site visits and interviews of ACO and/or PCT executives to test the hypotheses. Third, the breadth phase (i.e. the how much), will employ econometric analysis of panel data from the Dartmouth claims database, to estimate if different risk sharing schemes have differential impact on efficiency, taking into account of the results of the two previous steps.
Career Activity since Fellowship: