​​​​​​​Experts split on the financial success of accountable care organizations


The accountable care organization model has had its share of ups and downs, and two viewpoints published in the Journal of the American Medical Association are divided on whether they are truly successful.

The model is still in its infancy, and that completely discounting it would be a mistake, as ACOs show signs of promise as a payment and delivery model, write Zirui Song, M.D., a resident in the Department of Medicine at Massachusetts General Hospital in Boston, and Elliot S. Fisher, M.D., director of the Dartmouth Institute for Health Policy and Clinical Practice.

The principles that led to the creation of ACOs--unsustainable spending growth and disparities in care quality--are still viable, and aligning physicians together under a shared budget encourages cohesion, they said.

“At its core, the ACO model ties to align economic incentives with health professionals’ responsibility to do the right thing for patients,” they write in the commentary.

Song and Fisher call for more research on the efficacy of ACOs, as few studies on the model follow facilities using it for more than two years. Studies have found, though, both economic gains and quality improvements thanks to ACOs, they write.

But Kevin A. Schulman, M.D., and Barak D. Richman, disagree. In a separate commentary, they write that preliminary data indicates that ACOs have not successfully lowered the cost of care in a number of implementations. They’re also not the first to call the financial effectiveness of ACOs into question.

“There have been several iterations of the ACO concept, and none appears to have meaningfully reduced the cost of care,” Schulman, a professor of medicine and business at Duke University, and Richman, a law and business professor at Duke, write in the commentary.

“Even though mere nominal savings would be important, Medicare’s financial fragility and the increasing burden of healthcare costs for the baby boom generation demand policies that bend the cost curve more substantially.”

- here’s the first commentary
- read the second commentary