Des Jardins contributes book chapter about ACO history, payment and delivery models

September 3, 2021

Four healthcare professionals sit at a table looking over paperwork.In a new book chapter for Springer’s Handbook Integrated Care (2021), CHRT’s executive director, Terrisca Des Jardins, communicates the history of ACOs and how they are being studied not only for improving the U.S. healthcare system, but as a model for other countries.

The chapter, “Innovative Payment and Care Delivery Models: Accountable Care Organizations in the USA,” also includes future potential areas of consideration, such as the impact of COVID-19.

Accountable Care Organizations (ACOs) are “groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients” (CMS 2015). They differ from Health Maintenance Organizations (HMOs) by allowing patients more free choice in choosing their providers, as well as participating in a particular ACO. They also focus more on patient-centered care—especially primary care—instead of strict control of access as a means of reducing utilization.

To qualify for shared savings, ACOs must meet quality standards across 23 measures, covering four domains: patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk population. An ACO’s performance is captured through a mix of surveys, claims data, and other sources.

The Centers for Medicare and Medicaid Services (CMS) at HHS remains active in promoting new ACO approaches to achieve high quality care and cost savings. Preliminary results show that Medicare’s flagship ACO program generally has good quality of care and outcomes, as well as modest cost savings. However, it is still too early to judge complete success or failure based on financial or quality indicators.

In 2018, the Pathways to Success redesign accelerated the timeline for ACOs to assume greater financial risk. ACOs that accepted downside risk (reimbursing payers if spending exceeds a set benchmark) were more likely to achieve shared savings than those that only accepted upside risk (no penalty for spending exceeding a benchmark). This suggests that greater financial responsibility is associated with a stronger commitment in transforming health care.