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For managing the supply-demand imbalance in free-floating bike sharing systems, we propose dynamic hubbing (i.e., geofencing areas varying from one day to another) and hybrid rebalancing (combining user-based and operator-based strategies) and solve the problem with a novel multi-objective simulation optimization approach. Given historical usage data and real-time bike GPS location information, the basic concept is that dynamic hubs are determined to encourage users to return bikes to desired areas towards the end of the day through a user incentive program. Then, for the remaining unbalanced bikes, an operator-based rebalancing operation will be scheduled. The proposed modeling and optimization solution algorithm determines the number of hubs, their locations, the start time for initiating the user incentive program, and the amount of incentive by considering two conflicting objectives, i.e., level of service and rebalancing cost. In this study, for free-floating bike sharing, the level of service is represented by the walking distance of users for locating a usable bike, which is different from level of service metrics commonly used by station-based bike sharing, and the rebalancing cost is weighted incentive credits plus operator-based rebalancing cost. We implemented the proposed method on the Share-A-Bull free-floating bike sharing system at the University of South Florida. Results show that a hybrid rebalancing and dynamic hubbing strategy can significantly reduce the total rebalancing cost and improve the level of service. Moreover, taking the advantage of crowd-sourcing (or job-sharing) reduces negative impacts—energy consumption and greenhouse gas emissions—of the operation of rebalancing vehicles and makes bike sharing a more promising environmentally friendly sharing transportation mode.

In any society or group, the behavior and manner of acting that are highly rated can be estimated based on the level of appreciation given by the group to that level of behavior. This reward system will be studied to show the kinds of behavior group members are expected to get by the group and the kinds of behavior that - through the reward system - will be strengthened and perpetuated in the group. The study of the wage and incentive systems of Japanese factories revealed very well the differences between Western industry and modern Japanese industry. The study also showed both the types and magnitude of the differences that underlie attitudes and behaviors that distinguish modern industry in Japan from that in the United States. In the following discussion, the wage system in one factory will be examined in detail to illustrate the particular central trend that appears in all studied factories. Since the monetary wage system for work performed is only a part of the entire wage system, it will also examine the general pattern of non-monetary benefits, welfare efforts, incentive programs for workers, using specific plans and costs of a particular factory.

Objectives Organ donation is the driving force for transplant. Awareness about donation and transplant is invaluable for improved transplant services in any country. Our objective was to assess the knowledge and attitude toward organ donation and transplant among medically educated adult Iraqis versus adult Iraqis who were not medically educated, in Baghdad, Iraq. Materials and methods For this study, we recruited 400 Iraqi residents of Baghdad city from December 1, 2018, to March 1, 2019. We used an interviewer-adm-inistered questionnaire to survey 200 health care professionals and 200 adults who lacked medical education, and then we analyzed the responses from the 2 groups. Results The study included 165 males and 235 females (mean age 33.73 ± 10.38 years). Most participants (60%) were aware of organ donation, and a health care provider was the main source of their knowledge. Only 11.25% were aware of Iraqi legislation that permits donation after brain death. Nearly 50% of the participants volunteered to be living donors, and 229/400 (57.25%%) volunteered to donate after death. About 50% accepted the idea of organ donation as an act to save life, whomever the donor. The most important barrier was the fear of future risks to health after living donation and body disfigurement after death. There was a statistically significant difference in the knowledge and attitude scores between the 2 groups. From the study sample, 46.5% accepted the concept of incenting living donors or families of deceased donors. Conclusions Iraqi people are moderately informed about organ donation and transplant. Medically educated people demonstrated an attitude of greater acceptance. Religion and social beliefs were not barriers to organ donation in the study sample. Regulated governmental application of incentive programs may be a useful strategy at present.

Problem definition: Because of a prolonged decline in public transit ridership over the last decade, transit agencies across the United States are in financial crisis. To entice commuters to travel by public transit instead of driving personal vehicles, municipal governments must address the “last-mile” problem by providing convenient and affordable transportation between a commuter’s home and a transit station. This challenge raises an important question: Is there a cost-effective mechanism that can improve public transit adoption by solving the last-mile problem? Academic/practical relevance: In this paper, we present and analyze two incentive mechanisms for increasing commuter adoption of public transit. In a direct mechanism, the government provides a subsidy to commuters who adopt a “mixed mode,” which involves combining public transit with hailing rides to/from a transit station. The government funds the subsidy by imposing congestion fees on personal vehicles entering the city center. In an indirect mechanism, instead of levying congestion fees, the government secures funding for the subsidy from the private sector. We examine the implications of both mechanisms on relevant stakeholders. These two mechanisms are especially relevant because several jurisdictions in the United States have begun piloting incentive programs, in which commuters receive subsidies for ride-hailing trips that begin or end at a transit station. Methodology: We present a game-theoretic model to capture the strategic interactions among five self-interested stakeholders (commuters, public transit agency, ride-hailing platform, municipal government, and local private enterprises). Results: By examining equilibrium outcomes, we obtain three key findings. First, we characterize how the optimal interventions associated with the direct or the indirect mechanism depend on: (a) the coverage level of the public transit network; (b) the public transit adoption target; and (c) the relative strength of commuter preferences between driving and taking public transit. Second, we show that the direct mechanism cannot be budget-neutral without undermining commuter welfare. However, when the public transit adoption target is not too aggressive, we find that the indirect mechanism can increase both commuter welfare and sales to the private-sector partner while remaining budget-neutral. Finally, we show that, although the indirect mechanism restricts the scope of government intervention (by eliminating the congestion fee), it can dominate the direct mechanism by leaving all stakeholders better off, especially when the adoption target is modest. Managerial implications: Our findings offer cost-effective prescriptions for improving urban mobility and public transit ridership.

This paper provides evidence on a large-scale teacher incentive program in the state of Sao Paulo, Brazil, which awarded group bonuses to teachers and school staff conditional on improvements in student performance. By using a difference-in-differences and triple-differences framework, I show that the program had overall positive effects on student achievement, although improvements vary across grades and subjects. The robustness of the results is assessed through the use of a series of alternative counterfactuals. I also investigate whether initial school characteristics affect the impact of the program. Although it could be expected that free-riding effects increase with the number of teachers in schools, therefore limiting the impact of the program, this does not seem to be the case. More sizeable differences are found according to school's previous performance. Initially low-performing schools improved much more than the average, suggesting there may be considerable differences in the ability of schools to respond to this type of policy.

Problem definition: The U.S. influenza (flu) vaccine supply chain is decentralized and experiences frequent supply and demand mismatches caused by two key factors: (1) the vaccine production process (yield) is highly uncertain; and (2) individuals are self-interested and do not completely take into account positive and negative externalities that they impose on others. To improve matching of supply and demand, we counteract these factors by developing an ex ante budget-neutral incentive program. Academic/practical relevance: We establish the sources of inefficiency in the flu vaccine supply chain. To eliminate the inefficiency, we develop a two-sided incentive program that policymakers can implement to finance vaccines under an ex ante balanced budget. Methodology: We model the flu vaccine supply chain as a decentralized system consisting of self-interested individuals on the demand side, and a profit-maximizing manufacturer with uncertain yield on the supply side. We use backward induction to characterize the subgame-perfect equilibrium of the sequential game that models the interactions between individuals and the manufacturer. Results: We develop a two-sided incentive program that proposes “vaccination incentives” to be given to individuals on the demand side, and “a menu of transfer payments” between the social planner and manufacturer on the supply side. When the realized vaccine supply is high (or low), our incentive program provides positive (negative) vaccination incentives for individuals to stimulate (or curb) the demand and eliminate positive (or negative) externalities by making vaccination more affordable (or costly). When social benefits from vaccination are significantly high, our incentive program uses a menu of transfer payments to penalize (or subsidize) the manufacturer for low (or high) yield realizations so that it produces the socially optimal quantity. We show that our incentive program can attain the social optimum, maintain an ex ante balanced budget (i.e., budget-neutral in expectation), and distribute the maximum social welfare between individuals and the manufacturer arbitrarily. Managerial implications: Vaccination incentives to individuals can ensure their access to the vaccine, but they are not enough to entice the manufacturer to ensure vaccine availability. A menu of contracts contingent on realized yield provides necessary incentives to the manufacturer and assures the availability.

Murray-Darling Freshwater Research CentreMDFRC item.Landholder adoption of conservation practices has been extensively researched in dryland areas, but there has been less research into the adoption of biodiversity conservation practices in irrigation areas. The Murray Catchment Management Authority (MCMA) and Murray Irrigation Limited (MIL) in south-west New South Wales offer landholders monetary incentives to enhance native vegetation management. However, uptake of the incentives and recommended practices has been slower in the irrigation areas than in dryland areas serviced by the MCMA. We explored landholder participation in native vegetation management in the MIL area using semistructured interviews with landholders and extension staff. Our findings suggest there are important differences between irrigation and dryland contexts. Landholders in irrigation districts face higher opportunity costs and are more likely to mistrust government intentions. Other constraints to adoption include lack of financial resources, restricted time to carry out works and a high turnover of extension staff. Landholders adopted recommended vegetation management practices because those practices matched their values and goals. The importance of regular contact with a positive and enthusiastic extension officer was also evident. These findings have important implications for conservation policies and programs. Extension should move beyond arousing interest and include substantial follow-up contact to maintain landholder motivation and confidence, as well as provide recognition for past landholder efforts. Incentive programs should be designed to provide wider landholder support with different entry points allowing participants to adapt, learn and build confidence. Incentives should address the constraints experienced by landholders, particularly at times of peak workloads and during drought. Work targets set for field staff can be too high and result in program staff focusing on accomplishing on-ground work, rather than developing irrigators' longer-term commitment to vegetation conservation.

Governments in many countries have offered various incentives to promote the diffusion of electric vehicles (EVs).This study examines the effectiveness of various policy measures that underlie the rapid development of the EV market in China, by far the world's largest such market. The analysis is based on detailed data on EV sales, local and central government incentive programs, and charging stations in 150 cities from 2015 to 2018. The empirical framework addresses the potential endogeneity of key variables, such as local policies and charging infrastructure, by using a city-border-regression design and instrumental variable approach. We find that consumer subsidies for vehicle purchases accounted for more than half of EV sales in China. Nevertheless, investments in charging infrastructure were much more cost-effective than consumer subsidies. An inexpensive policy that merely provided EVs with a distinctive, green license plate was strikingly effective. These findings demonstrate the varying efficacy of different policy instruments and highlight the critical role of the government in promoting clean technologies.

Rationale: A trial of four financial incentive programs, conducted at CVS Caremark, a large employer, documented their effectiveness in promoting sustained abstinence from smoking, but their cost-effectiveness is unknown, and the significant up-front cost of the incentives is a deterrent to their adoption. Objectives: To determine the cost-effectiveness of these incentives from the healthcare sector and employer perspectives. Methods: This study examines a decision model built with trial data, supplemented by data from the literature. Life-expectancy gains for quitters were projected on the basis of U.S. life tables. The two individual-oriented programs paid $800 for smoking cessation at 6 months; one required participants to deposit $150 at baseline. Payments in the two group-oriented programs varied with the group’s success; again, one required participants to deposit $150. Results: Life-years, quality-adjusted life-years (QALYs), costs (2012 dollars), and cost-effectiveness ratios are described. From the healthcare sector perspective, costs ranged from $3,200 per life-year ($2,500 per QALY) for the competitive deposit program, compared with usual care, to $6,500 per life-year ($5,100 per QALY) for the individual reward program. From the employer perspective, costs ranged from $256,600 per life-year gained for the individual deposit program to $1,711,100 per life-year gained for the individual reward program; the cost per QALY ranged from $65,300 for the competitive deposit program to $128,800 for the individual reward program. Cost-effectiveness from the employer perspective improved with longer decision horizons. Including future medical costs reduced cost-effectiveness from both perspectives. Conclusions: Four financial incentive programs that paid smokers to quit are very cost-effective from the healthcare sector perspective. They are more expensive from the employer perspective but may be cost-effective for employers with longer decision horizons.

Novel business models can be implemented through digital platforms to enable better circular economy (CE) performance in the renewable energy industry. For example, blockchain can assist in developing innovative business models throughout the solar photovoltaic energy ecosystem (SPVEE) to improve CE. Ranked fifth in total installed photovoltaic (PV) capacity, Turkey, as a developing country, should take the necessary steps and make progress towards achieving CE in the SPVEE. The solar PV industry requires further innovation to address the negative environmental impact of existing linear business models. To ensure favorable results, identifying and evaluating critical success factors (CSFs) are necessary. However, no study has investigated CSFs for SPVEE or any other renewable energy source to achieve a blockchain-based infrastructure towards increased CE performance. Therefore, the goal of this study is to identify and examine the CSFs to improve the performance of a blockchain-based SPVEE towards CE in Turkey. To this end, first, the CSFs for blockchain-based SPVEE were identified through both a literature review and the Nominal Group Technique (NGT). Then, Intuitionistic Fuzzy (IF)-DEMATEL was used to explore their interrelationships based on the expert data. Finally, IF-DELPHI was employed to validate the results. Our findings suggested that effective government incentive programs and regulations are significant for blockchain-based SPVEE towards CE in Turkey. The findings of this study assist macro and micro decision-making in the potential implementation of blockchain in Turkish SPVEE to improve CE. They are also invaluable for other countries and can be used as a reference point.

Community supported agriculture (CSA) programs are emerging as popular consumer options for pro­duce acquisition. While many researchers have dis­cussed the impacts of CSA on economies, commu­nities, and the environment, others are interested in documenting how produce-based CSA shapes health. In this paper, we evaluate whether and to what extent CSA incentive programs, funded by diverse employer groups in central Kentucky 2015–2018, impact shareholder wellness. To evaluate impact, we use two distinct types of data: we com­pare shareholders’ perceived frequency of food lifestyle behaviors from pre- and post-season sur­veys, and we examine anonymized medical claims from a subset of these participants to determine if CSA participation impacts short-run usage of medical services. From survey data, we observed statistically significant changes in some shareholder behaviors. For instance, CSA shareholders per­ceived that they consumed vegetable salads more often while decreasing their intake of processed foods and snacks. From medical claims data, share­holders are billed less in diet-related medical claims following CSA participation compared to a control group from the same employer organization. In short, we find that CSA is generally beneficial and participants view their experience as providing motivation to reshape their relationship to food. We conclude by offering strategies for institutions and organizations to effectively develop and support CSA incentive programs.

Maternal health care services should be accessible to all women during pregnancy, delivery, and the postpartum period. The majority of maternal deaths can be prevented if women utilize maternal health care services appropriately. This study aimed to assess the utilization of maternal health services and explore the barriers in accessing maternal health care services. This descriptive cross-sectional study was conducted among 48 mothers over the age of 18 with one or more children. The data was obtained by interview and focus group discussion using the structured questionnaires and checklists, which included socio-demographic characteristics, and utilization of antenatal care, delivery practice, and postnatal care services. Among 48 mothers, only 35.41% used complete antenatal care services, 66.66% received TT vaccine during pregnancy, 54.16% delivered their last child at the hospital, and only 27.08% received postnatal services as recommended by the World Health Organization. The antenatal care services and delivery services were utilized suboptimally, and postnatal care visits were significantly lower. Socio-economic factors such as family income and education of women correlated considerably with maternal health care utilization. Women with higher education levels and higher family income were more likely to go for frequent antenatal check-ups, have TT vaccinations, deliver in hospitals, and visit more postnatal check-ups than women with lower education levels and lower family income. The findings indicate that there are unmet needs of maternal health care access to women living in the squatters of Nepal. It is therefore important to implement targeted incentive programs and maternal health awareness campaigns to increase the utilization of maternal health services among women living in squatter settlements in Nepal. Key words: Antenatal, Delivery, Postnatal, Maternal health services, Squatter.

Motivation is considered one of the most important prerequisites for the success and effectiveness of the resulting performances. Usually, we meet only with a perspective of employee motivation from inside the company. However, the external environment, i.e. macro-environment, also influences the motivation of employees. We decided to focus on exploring how macroeconomic indicators evolution affects employee motivation. By means of the research conducted in Slovakia during the period from 2008 to 2019 on a sample of more than 30,000 respondents, we define the dependence of selected macroeconomic indicators and employee motivation. The research focuses on the analysis of average annual wage and household debt influence on the most important employees’ motivational factors. Based on our findings, we can state that macroeconomic indicators affect the importance of motivational factors in Slovakia. Especially, the average annual wage strongly influences the six motivational factors (communication at the workplace, duties and type of work, working hours, working environment, superior approach, psychological burden). The results of the research also show that the seven motivational factors (atmosphere at the workplace, good team, communication at the workplace, working hours, working environment, superior approach, psychological burden) strongly depend on the macroeconomic indicator of household debt. Therefore, when creating incentive programs, business managers in Slovakia should take into account not only the effects of the company’s microenvironment on motivation but also the effects of the macro-environment and thus macroeconomic changes in the state. The role of a manager is to keep balance between external environment influence on employee motivation and internal actions. The paper presents inspiring ideas in a field of employee motivation and the influence of external environment on motivation.

This study marks an early attempt to evaluate staycation incentive programs initiated by local authorities. It aims to gauge the effectiveness of staycation programs in cultivating learning opportu...

This study aimed to determine the workload of the workers to be used for incentive plan in the Quality Control Division, Company X. Studying work characteristics, a work sampling technique was used. Two workers from this QC division were participated in the study. A number of 440 observation were taken from each Worker 1 and Worker 2. Results showed that the percentages of productive time are 93.62% for Worker 1 and 91.81% for Worker 2. Meanwhile for workload resulted 151% and 138% for Worker 1 and Worker 2 (classified as overload for both workers). This study recommended the company to add one more worker to help in this workstation to reduce the workload of these two workers

This paper explores the adoption choice of electronic medical records by U.S. hospitals, which could exhibit strategic complements or substitutes. I find complementarities in adoption through a reducedform analysis with instruments for unobserved market characteristics. I further develop a dynamic oligopoly model to allow for strategic timing incentives that are missing in the static model. Adopting a dominant local vendor could increase perperiod profits from adoption by 9.2% over choosing a marginal vendor. A counterfactual analysis suggests an incentive program rewarding coordination, not just adoption, is more effective in achieving interoperability, especially before the widespread adoption of the technology.

INTRODUCTION The objective of this study was to assess whether inhaled corticosteroid (ICS) prescription rates for patients with poorly controlled asthma presenting to the emergency department (ED) remained high with a clinical support system in place, after a financial incentive program ended. This study is the second phase of a previous study done at our institution. The first phase demonstrated that the introduction of an electronic alert system advising providers to prescribe ICS to patients with poorly controlled asthma, along with a financial incentive, increased ICS prescription rates from 2% to 77%. Clinical support systems are necessary to improve control for patients with asthma, as prescribing ICS in the ED has not previously been standard of care. METHODS This retrospective study identified 96 eligible patients during the study period of January 1, 2019 to December 31, 2019. Subjects included patients aged 4-18 with at least two ED visits for asthma within 365 days and no recent ICS prescription. For subjects meeting these criteria, an electronic alert activated, advising the provider to prescribe ICS. RESULTS ICS prescription rate without the incentive remained high at 0.74 (0.59, 0.86) and was not significantly different than the rate with the incentive of 0.77 (0.65, 0.87), with p value 0.82. No significant differences were detected in baseline characteristics between patients discharged with and without an ICS prescription. CONCLUSIONS This study confirmed that an electronic alert advising ICS prescription in the ED for patients with recurrent asthma visits is effective, even without a financial incentive.

Childhood characteristics other than social background may affect work motivation in adulthood. In this research we assess the influence of childhood migration experience on adult work motivation from the perspective of work motivation theory, based on data from the 2016 China Labor-force Dynamic Survey. We use propensity score matching and weighted multiple linear regressions while controlling for the city effect. The results suggest that the effects of childhood migration experience on work motivation are causal: those with such experience are more likely than those without to be driven by social factors and less likely be driven by economic factors. The results also highlight the significant moderating role of social integration as a mechanism through which the experience of migration in childhood affects adults’ levels of work motivation, both economic and social. The moderate effect is more pronounced among male and rural adults. Our findings indicate that entrepreneurs should consider employees’ experiences and formulate more targeted incentive programs to improve employees’ organizational commitment and performance.

BACKGROUND In 2012, the Centers for Medicare & Medicaid Services started levying performance-based financial penalties against outpatient dialysis centers under the mandatory End-Stage Renal Disease Quality Incentive Program. OBJECTIVE To determine whether penalization was associated with improvement in dialysis center quality. DESIGN Leveraging the threshold for penalization (total performance score < 60), a regression discontinuity design was used to examine the effect of penalization on quality over 2 years. Publicly available Medicare data from 2015-2018 were used. The effect of penalization at dialysis centers with different characteristics (for example, size or chain affiliation) was also examined. SETTING United States. PARTICIPANTS Outpatient dialysis centers (n = 5830). MEASUREMENTS Dialysis center total performance scores (a composite metric ranging from 0 to 100 based on clinical quality and adherence to reporting requirements) and individual measures that contribute to the total performance score. RESULTS There were 1109 (19.0%) outpatient dialysis centers that received penalties in 2017 on the basis of performance in 2015. Penalized centers were located in ZIP codes with a higher average proportion of non-White residents (36.4% vs. 31.2%; P < 0.001) and residents with lower median income ($49 290 vs. $51 686; P < 0.001). Penalization was not associated with improvement in total performance scores in 2017 (0.4 point [95% CI, -2.5 to 3.2 points]) or 2018 (0.3 point [CI, -2.8 to 3.4 points]). This was consistent across dialysis centers with different characteristics. There was also no association between penalization and improvement in specific measures. LIMITATION The study could not account for how centers respond to penalization. CONCLUSION Penalization under the End-Stage Renal Disease Quality Incentive Program was not associated with improvement in the quality of outpatient dialysis centers. PRIMARY FUNDING SOURCE None.

Background Complete Eats Rx is a fruit and vegetable prescription program designed to incentivize fruit and vegetable consumption among Supplemental Nutrition Assistance Program (SNAP) participants via $10 incentives distributed either weekly or per encounter to purchase fruits and vegetables at a mid-price supermarket chain in Washington State. Objective To better understand SNAP participants’ experience, and to determine perceived impacts and consequences of the program. Design Qualitative analysis of nine photovoice sessions. Participants chose the topics for discussion. Sessions were audiorecorded and transcribed. Thematic content analysis was performed to identify key emergent themes using Atlas.ti. Setting Spokane, Seattle, and Yakima, Washington. Participants Twenty-six individuals who received a fruit and vegetable prescription within the past 6 months, 23 of whom attended all three photovoice sessions offered at their site. Participants were recruited from three participating health care or public health organizations in Spokane, Seattle, and Yakima, Washington. Analysis Transcriptions were coded using inductive methods. Coded statements were organized into major themes. Coding structures and analysis were strengthened by iterative interactions between researchers. Results Participants reported Complete Eats Rx was an important resource for families and improved food security, diet quality, and the ability to purchase healthy foods, including a greater variety of fruits and vegetables. Primary barriers to food security and fruit and vegetable consumption included limited geographic accessibility and the high cost of fruits and vegetables, exacerbated by other financial constraints such as rising housing costs. Participants reported supermarket checkout difficulty because of embarrassment, stigmatization, and inability to redeem incentives. The most frequently mentioned barrier to perceived program acceptability was having only one supermarket chain as the acceptor of the incentive. Conclusion Partnering with supermarkets to accept fruit and vegetable incentives is a unique strategy to increase produce purchasing that can be adopted by other localities. Focus on geographic accessibility, appropriate price points, and positive shopping experiences via expansion to local grocers, improvements in staff interactions, and a transition to an electronic system may improve incentive redemption and usability.

BACKGROUND Accountable care organizations (ACOs) are a recent incentive program that are designed to address inefficiencies in the U.S. health care sector. To meet their design objectives, ACO participants must engage in greater electronic health information exchange (HIE) practices both internally and externally with care participants, such as patients and other providers. PURPOSE The aim of this study was to examine the relationship between hospital participation in ACOs and electronic HIE practices with different participants of care and how these practices vary differentially across market types. APPROACH Grounding our work in the reward-motivational view of organizational action, we proposed hypotheses that linked hospital participation in ACOs to three dimensions of HIE practices (intraorganizational, interorganizational, and provider-patient HIE practices). We tested our hypotheses by analyzing a sample of 1,926 hospitals. RESULTS Hospital participation in ACOs is associated with greater intraorganizational and provider-patient HIE practices, but not interorganizational HIE practices. We also found that whereas the relationship between ACO participation and intra- and interorganizational HIE practices remains unchanged irrespective of the degree of competition in the health care market, the relationship between ACO participation and provider-patient HIE practices holds true only for hospitals operating in noncompetitive markets. PRACTICE IMPLICATIONS Our results showed that hospitals participating in ACOs vary in their HIE practices, and attributes of the local market in which ACO participants operate in contribute to this variation. These insights should provide guidance to researchers, policymakers, and hospital administrators who aim to improve the effectiveness of ACOs.