Care Transformation Strategies and Approaches of Accountable Care Organizations

Abstract

Although accountable care organizations (ACOs) proliferate, little is known about the activities and strategies ACOs are pursuing to meet goals of reducing costs and improving quality. We use semistructured interviews with executives at 16 ACOs to understand ACO approaches. We identified two overarching ACO approaches to changing clinical care: a practice-based transformation approach, working to overhaul care processes and teams from the inside out; and an overlay approach, where ACO activities were centralized and delivered external to physician practices. We additionally identified four methods ACOs were using to achieve their aims: using patient support roles; targeted clinics, events, programs, and interventions; clinical process standardization; and tracking and identifying patients on which to focus resources. We expect that ACOs using either of the major approaches can succeed under current ACO programs, but that as value-based payment programs mature, ACOs will need to undertake practice-based approaches to be successful in the long term.

Association of Physician Group Participation in Accountable Care Organizations With Patient Social and Clinical Characteristics

“…The ACO-participating physicians may be more focused on effectively managing chronic illnesses and better equipped to do so. 28 …”

Strengthening community support, resilience programmes and interventions in infectious diseases of poverty

“…Social resiliency and social equality can lead to the benefits of lower infection rates and associated treatment costs, increasing health care access and risk reduction strategies in order to improve livelihood and productivity in countries that are prone to infectious diseases and pandemic threats (3,7,25,30,35).…”

“…Communities can become less engaged as disease incidence declines, and consequently less involved in control activities, or start actively refusing vaccination. Once elimination and eradication have been achieved, returns on investment, health and economic benefits are potentially infinite (4,10,35).…”

“…This should rely on the value of products to patients/ populations end-users applications and frameworks for measuring quality and cost-effectiveness of healthcare interventions (i.e., mass drug treatments, immunization, preparedness and surge capacity, etc.) to those in need in remote and low-resource settings (3,4,17,20,35).…”

Low-Value Care and Clinician Engagement in a Large Medicare Shared Savings Program ACO: a Survey of Frontline Clinicians

“…Research has primarily relied on data gathered from surveys and interviews of ACO executives and physician leaders. [12][13][14][15][16] A recent national survey of primary care physicians (PCPs) and internal medicine specialists during the early ACO experience (2014-2015) found that Medicare ACOs had limited success engaging physicians in decision-making, awareness of ACO incentives, or changing care delivery. 17 However, there are no data on ACO engagement of other physician specialists (who make an outsized contribution to total spending), physician assistants, or advanced practice nurses.…”