Placement: Harvard T.H. Chan School of Public Health
Mentor: Sara Singer, Ph.D., M.B.A. (Professor of Health Care Management and Policy, Harvard T.H. Chan School of Public Health)
Project Title: Care Transitions in Accountable Care Organizations
Natacha Lemaire M.B.A., M.P.A., M.Sc., is a 2016-17 French Harkness Fellow in Health Care Policy and Practice. She has over 15 years of experience in health policy in different capacities, within the French Ministry of Health and Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés, the French national health insurance fund. In her current role at the French Ministry of Health, she is responsible for the coordination of Ministry directorates to implement the National Health Strategy, and supports the Secretary General in monitoring the network of the 26 regional health agencies. Within the ministry, she has also served as Head of the regulating division for the Directorate of Healthcare Supply, where she worked on hospital pricing and developing a national guide for regional schemes of health organizations. Her previous work at Caisse Nationale de l'Assurance Maladie des Travailleurs Salariés was timed with the implementation of the health insurance reform in 2004, where she worked on setting up the pilot for the first disease management program in France. The pilot was launched in October 2008 and was extended nationwide for diabetic patients in 2012, with more than 600,000 beneficiaries today. Lemaire received a master’s in business administration from ESSEC Business School, a master’s in health sociology from the Université Paris-Sorbonne, and a master’s in public administration from École Nationale d'Administration.
Better coordination of care is a key objective of national policies in both the U.S. and France. In France, many self-employed physicians still work in solo practice, and group practices are small and do not often employ other healthcare professionals. Independent physicians in France stand to benefit from grouping themselves for the purpose of developing shared services they could not afford on their own. The general objective of this research is to understand the evolution over time of Accountable Care Organizations (ACOs) primarily owned by and composed of physicians working in small practices. ACOs are supposed to provide an innovative, patient-centered opportunities to improve care coordination using contract and funding mechanisms as leverage between care providers. The ways that physician-led ACOs are organized to manage the care transitions of their patients with providers outside the ACO and hospitals in particular will be studied.
As ACOs in the U.S. are very heterogeneous, this work will contribute to the current understanding of ACO characteristics, frameworks, and arrangements. Through detailed case studies of ACOs, the analysis will focus on cooperation at multiple levels, and will attempt to characterize their key challenges, as well as their strengths and weaknesses in care coordination and care management. Patient experiences and communication with physicians, focusing on their engagement, will be considered as measures of success or failure. The transferability of lessons learned to the French healthcare system will be discussed with the goal of improving care coordination delivery and enhancing primary care.