Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review

Abstract

Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2). The most consistent associations between ACO implementation and outcomes across payer types were reduced inpatient use, reduced emergency department visits, and improved measures of preventive care and chronic disease management. The seven studies evaluating patient experience or clinical outcomes of care showed no evidence that ACOs worsen outcomes of care; however, the impact on patient care and outcomes should continue to be monitored.

Can accountable care organisations really improve the English NHS? Lessons from the United States

“…A recent systematic review of 42 studies found that, across all payer types, the most consistent associations between ACO implementation and care outcomes were in reduced inpatient use, reduced emergency department visits, and improved measures of preventive care and chronic disease management 20. The most recent evidence finds no difference in quality or spending by ACO type (for example, large integrated systems versus smaller physician led ACOs) 21.…”

Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data

“…There has been mixed success with ACO models and related value-based payment approaches (eg, pay for performance) in terms of organizational transformations that lead to improved cost and quality outcomes raising the question of why some provider organizations succeed and others fail. [3][4][5][6][7] The answer to this question may lie in the specific configuration of internal mechanisms (eg, electronic health records) for performance improvement adopted by provider organizations facing new expectations for quality improvement and cost control. While ACO contracts change the incentives between the payer and the provider organization, in organizations that are not owned by frontline clinicians, improvements may also require aligning the incentives further downstream to reach frontline clinicians.Research has shown that financial incentives may influence the behavior of frontline clinicians in ACOs and thus the quality of care for patients, though the optimal design of such incentives remains a subject of debate.…”

How does being part of a pediatric accountable care organization impact health service use for children with disabilities?

“…The ACO model is viewed as a potential solution to the critical need for coordinated care, and many state policy makers are actively promoting the ACO as a way to improve quality and lower costs in Medicaid programs . Yet the existing evidence about ACO performance focuses heavily on Medicare and commercial ACOs with relatively little empirical evidence on ACO performance for high‐risk Medicaid populations . Moreover, we have no knowledge of health service use of high‐risk pediatric patients under the ACO model.…”

“…[6][7][8] Yet the existing evidence about ACO performance focuses heavily on Medicare and commercial ACOs with relatively little empirical evidence on ACO performance for high-risk Medicaid populations. 9 Moreover, we have no knowledge of health service use of high-risk pediatric patients under the ACO model.…”