ACOs Struggle with Operational and Financial Challenges

Accountable Care Organizations (ACOs) seek to promote care coordination, wellness and disease prevention through primary care.  More than 400 organizations have said they will seek to apply for accountable care contracts in 2013.  Although accountable care is designed around primary care, the costliest patients often rely on specialists to manage complex diseases.  Consequently, new strategies may involve joint efforts to manage patient care between primary care and specialty physicians.  Integration of an independent practice into the ACO, however, faces some challenges, including diverse IT systems.

As accountable care moves from theory and policy to practice, hospitals and physicians are grappling with new strategies and investments that they hope will be the most likely to achieve higher quality and lower costs.

Under accountable care, hospitals and physicians receive financial incentives to achieve quality gains and reduce healthcare spending.  The payment model has gained a foothold among commercial insurers and Medicare.  Unfortunately, to date 70% of ACOs are merely breaking even!

Some changes were made earlier this year including Medicare reducing the quality measures from 65 to 33.  Additionally, officials agreed to offer one of two payment options without the risk of a potential penalty.

In short, it is too early to give any indication of quality improvement or cost savings.

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