讲者：Dr. Dawei Jian 美国威斯康辛大学助理教授

时间：2026年6月16日（周二） 10：00

地点：同济大厦A楼509教室

ABSTRACT | 课程摘要

Medicare’s Shared Savings Program (MSSP) rewards accountable care organizations (ACOs) for reducing spending relative to expenditure benchmarks. The 2018 Pathways to Success reform accelerated ACOs’ transition into two-sided risk, yet savings stagnated, quality did not improve, and selective participation intensified. We argue that this underperformance reflects two interacting design failures: ratchet effects, whereby current savings tighten future benchmarks and weaken investment incentives, and risk sensitivity, whereby ACOs facing downside exposure avoid risk-bearing contracts or exit the program when forecast uncertainty is high. Using an 11-year MSSP panel of approximately 1,028 ACOs, we document three empirical patterns: switching to two-sided risk does not improve within-ACO performance; many one-sided ACOs forgo positive expected gains from risk-bearing tracks, especially under greater forecast volatility; and exit is concentrated among weaker and more risk-sensitive performers. Motivated by this evidence, we develop and estimate a dynamic structural model in which ACOs differ in evolving spending-reduction ability and risk sensitivity, choose whether to participate and which track to enter, and exert unobservable spending-reduction effort. We characterize the optimal dynamic policy, which combines prospective benchmark commitment, incentive shielding through benchmark compensation, and dynamic screening on risk preferences. Counterfactual analyses show that Pathways reduced savings relative to the legacy design, while the estimated optimal policy substantially improves cost reduction. Decomposition exercises indicate that both resolving ratchet effects and mitigating risk-sensitive selective participation are central to these gains. The results suggest that MSSP should rely less on accelerating two-sided risk and more on prospective benchmarks and risk-shielded incentive design.

GUEST BIO | 讲者介绍

Dr. Dawei Jian is an Assistant Professor in Supply Chain & Operations Management at the Lubar College of Business, University of Wisconsin–Milwaukee. His research focuses on incentives and information management within business contexts, especially in the areas of supply chain management, compensation design, healthcare operations, and OM-Marketing interface. The methodologies are dynamic optimization, game theory, mechanism design, information design, and structural modeling. His work has been published in Management Science and Production and Operations Management.