The new frontier of strategic alliances in health care: New partnerships under accountable care organizations

Abstract

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs – 81% – involve new partnerships between independent health care organizations. These “partnership ACOs” generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care.

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

“…ACOs depend on partnerships between multiple organisations, which often have little experience of working together 12. The same is true for STPs and vanguards in the NHS 28.…”

Explaining Sluggish Savings under Accountable Care

“…As a result, participating organizations include both long-standing integrated systems and more recently formed entities, such as hospitals and private practices that came together to pursue ACO contracts. 2 Understanding this diversity – and associated variation in performance – may provide insight into how to accelerate improvement.…”

“…First, most ACOs are not pre-existing organizations, but collections of independent providers pursuing an ACO together, such as a community hospital and local private practice physicians newly partnered. 2 These new organizations must accomplish a great deal of foundational work, such as forming a board; determining how to share bonuses; and completing tasks that require internal coordination, such as reporting. They then must agree upon and implement a joint strategy to pursue cost savings.…”

Trust, Money, and Power: Life Cycle Dynamics in Alliances Between Management Partners and Accountable Care Organizations

“…First, though the Centers for Medicare and Medicaid Services (CMS) intended ACOs to have tight organization and governance, empirical work on ACOs shows this typically is not the case (eg, D'Aunno et al . and Lewis et al …”

“…Health care providers may be prompted to seek partners for a variety of reasons; these reasons in turn can influence which partners the providers choose. Research suggests that threats from their external environments (eg, a turbulent health care market), opportunities (eg, new Medicare programs), and uncertainty motivate providers to seek partners . The current health care landscape may provide both uncertainty about health care payment and new opportunities in the form of initiatives from payers (such as ACO programs).…”