The services accountable care organizations provide to their patients may also benefit non-ACO patients.
That's because ACO providers will often up the level of care they offer to patients who aren't members of the program if they identify inequities in care, according to a a blog post on NEJM Catalyst.
Researchers at the University of California Berkeley interviewed 40 leaders, clinicians and other staff at four ACOs--one enrolled in the Pioneer ACO program and three in the Medicare Shared Savings Program--and found that employees wanted to ensure that patients covered by insurance or other means received the same level of care as those under an ACO risk-bearing contract.
This "spill-over effect" was beneficial to both the provider and patient. Providers didn't have to learn the ins-and-outs of each individual’s healthcare coverage, and all patients received new, improved levels of care.
“We’re not doing anything special for (ACO) patients versus anybody else,” one of the interviewed leaders told the research team. “The point is, we’re doing the right thing for the customer, and that’s what we’re gonna stay focused on.”
However, the ACO leaders did note they sometimes faced challenges when they tried to standardize care, including financial constraints and disputes with non-ACO payers.
The researchers encouraged policymakers in the Centers for Medicare & Medicaid Services to find ways to encourage ACOs to continue the process of “leveling-up” to maximize the “spillover” benefits to non-ACO patients, according to the post. Value-based care initiatives outlined in MACRA and other new models may also help speed up the process.