ACO Contracts With Downside Financial Risk Growing, But Still In The Minority

Abstract

Success of the accountable care organization model may require stronger financial incentives, potentially by including downside financial risk in contracts. Using the National Survey of ACOs, we explored changes in ACO structure and contracts over time. Though the number of ACO contracts and proportion with multiple contracts has grown, the proportion of ACOs bearing downside risk increased only modestly.Accountable care organizations (ACOs) have emerged as one of the most broadly implemented value-based payment models by both public and private payers. With incentives to improve the quality of care and reduce health care spending, the ACO model has grown to include 1,011 ACOs in 2018, covering an estimated 32.7 million lives and representing 1,477 different public and commercial payment arrangements.(1) While the Centers for Medicare and Medicaid Services (CMS) has introduced new ACO programs, debates continue around the impact of the ACO model, including the contribution of downside risk, where ACOs that fail to meet their financial targets share responsibility with payers for losses.(2)We used data from the National Survey of Accountable Care Organizations, administered four times from 2012 -2018 to analyze the evolution of ACOs. Twenty eight percent of ACOs formed in 2012 initially had a contract with downside risk (Exhibit 1). The proportion of ACOs taking on downside risk at the time they formed has varied over time, in part based on Medicare program initiation (e.g. Pioneer and Next Generation ACO programs could only be joined in 2012 and 2016 respectively). In 2018, 33% of ACOs report having at least one contract with downside risk. Though the increase in the proportion of ACOs with a downside risk contract is modest, the number of ACOs has grown roughly fivefold since 2012 (1), potentially indicating that the number of ACO downside risk contracts has also grown substantially. Study Data and MethodsTo improve our understanding of the rapidly growing number of ACOs, we fielded the National Survey of ACOs to all known ACOs in 2012. We fielded Waves 2 and 3 to

10 Jahre Accountable Care Organizations in den USA: Impulse für Reformen in Deutschland?

“…Zur Kostenreduzierung fokussieren ACOs auf die Optimierung von Patientenpfaden 53 , die Versorgungskoordination 54 und die Reduzierung von Leistungen von niedriger medizinischer Wertigkeit 55 . Auch versuchen sie, die Leistungsinanspruchnahme außerhalb des ACO-Netzwerks zu reduzieren 56 57 .…”

Translating Evidence into Practice: ACOs’ Use of Care Plans for Patients with Complex Health Needs

“…3,33 Most ACOs had to rely on patients to tell them about upcoming or recent specialist appointments. Only two ACOs, both part of highly centralized healthcare delivery systems, which are only half of ACOs in 2018, 42 implemented system-wide initiatives to fully integrate specialist and primary care clinicians into care plans. Even ACOs which include hospitals in their contract may struggle to coordinate care across settings, and they report similar care delivery capabilities as ACOs without a hospital.…”

Medicare accountable care organization characteristics associated with participation in 2‐sided risk

“…A study based on the National Survey of ACOs found that, between 2012 and 2018, the proportion of Medicare ACOs with 2-sided risk was smaller than those of commercial ACOs and multicontract ACOs. 12 A 2018 survey conducted by the National Association of ACOs revealed that, among Track 1 SSP ACOs facing the policy requirement to move to 2-sided risk in their next contract, 71% of respondents indicated that they were likely to leave the program if being forced to assume downside risk. 13 ACOs with different characteristics may be more or less prepared to assume downside risk.…”