The impacts of accountable care organizations on patient experience, health outcomes and costs: a rapid review

Abstract

Objectives Accountable care organizations were implemented as a system-level approach to address quality differences and curb increasing healthcare costs in the United States of America, and have garnered the interest of policy makers in other countries to support better management of patients. The objectives of this paper are to: (1) identify the impacts of accountable care organizations on improving the quadruple aim goals of improving patient experience of care, enhancing population health outcomes, reducing the per capita cost of health care and ensuring positive provider experiences and (2) determine how and why such impacts have been achieved through accountable care organizations. Methods We used a rapid review approach, searching Health Systems Evidence (for systematic reviews) and PubMed (for reviews and studies). Results were reviewed for inclusion independently by two researchers. Data were extracted by one reviewer and checked for consistency by another. Results We identified one recent systematic review and 59 primary studies that addressed the first objective ( n = 54), the second objective ( n = 4) or both objectives ( n = 1). The reviewed studies suggest that accountable care organizations reduce costs without reducing quality. Key findings related to objective 1 include: (1) there are positive trends across the quadruple–aim outcomes for accountable care organizations as compared to Medicare fee-for-service or group physician fee-for-service models; (2) accountable care organizations produced modest cost savings, which are largely attributable to savings in outpatient expenses among the most medically complex patients and reductions in the delivery of low-value services; (3) accountable care organization models met the majority of quality measures and perform better than their fee-for-service counterparts and (4) there is relatively little evidence about the impact of accountable care organizations on provider experience. Qualitative studies related to objective 2 highlighted mechanisms that were important for enabling accountable care organizations, including supplemental staff to enhance coordination and accountable care organization-wide electronic health records. Conclusions General trends and increased adoption of models similar to accountable care organizations outside of the USA suggest that these models outperform traditional fee-for-service models across the quadruple aim goals, although with mixed evidence about health outcomes.

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

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Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States

“…We are unaware of information on the effect of Accountable Care Organizations (ACOs) or other alternative payment models on the demand for care, physician incomes, or physician location, and the scant available information on provider experience suggests that it may be mixed. 34 ACO penetration grew considerably between 2010 and 2019, but the rate of growth was slightly higher in the first half of this period, preceding implementation of the ACA, compared with the second half. 35 Moreover, ACOs are present in every state, and our analysis of data presented in Muhlestein et al 35 indicates that penetration differs only slightly between expansion and nonexpansion states (Online Appendix H, Supplemental Digital Content 1, http://links.lww.com/MLR/C193 ).…”

Revitalizing Primary Care, Part 2: Hopes for the Future

“…9 A 2020 review found little evidence on ACOs and clinician experience. 8 Shared savings coming to an ACO may go to hospitals, specialists, and ancillary services, rather than to primary care. ACO savings are unlikely to improve primary care spend.…”