Developing an accountable care organization (ACO) that motivates doctors to participate and deliver high-quality, low-cost care can be a lot like building a baseball diamond in a corn field.

"The last thing you want is to build it and have nobody come," Doug Chaet, senior vice president of contracting and provider networks at Independence Blue Cross, told FierceHealthPayer in an exclusive interview.

More than 90 percent of the healthcare delivery systems in the Philadelphia region has embraced IBC's ACO payment model, largely due to allowing for provider input and testing models with providers before implementation.

IBC was an early adopter of accountable care, launching its initial ACO model about three and a half years ago that touched the entire delivery system. Since then, the model hasn't evolved but rather matured, in terms of provider acceptance and adoption, Chaet said.

Given that providers are largely responsible for care delivery, IBC knew it had to align incentives for all components of the delivery system to ensure effective management of patients across the continuum of care. And not only must insurers align incentives, they must be generous with them as well.

"A lot of being asked of them and reimbursement is dwindling. If you really want them to do more, you have to compensate them fairly so they can afford to do more for fewer patients and manage them comprehensively," Chaet noted.

Insurers can't expect doctors to behave differently under an ACO model with a 5 percent to 10 percent bonus program, said Chaet, who emphasized that primary care providers can more than double their base reimbursements in IBC's ACO model.

In addition to substantial incentives, a successful ACO partnership needs provider engagement. "You absolutely have to put the doctors in the driver seat and focus on being a primary care-driven organization--they're the quarterbacks of our healthcare delivery system," Chaet said.

To engage physicians in accountable care efforts, payers will have to make some tough strategic decisions and recognize that not all providers practice medicine alike. Chaet also recommended payers put a strong focus on referral management.

Luckily for insurers entering the ACO world, providers have embraced value-based reimbursement. Because of that, Chaet said he expects to see significant growth for commercial payers, with the expansion of current ACO programs and increased adoption from the provider community.