A global look at accountable care organizations

Hospital entance
Accountable care could flourish outside of the U.S., according to a new study. (Getty/monkeybusinessimages)

Accountable care organizations are now beginning to show success in cost reductions and quality improvements in the U.S., and lessons from these programs can be applied internationally. 

Researchers at Duke University, Imperial College London and the Primary Care Corporation in Doha, Qatar, identified key elements of the accountable care framework and applied those principles to pilots in Nepal, Germany and the Netherlands, according to a study published in Health Affairs. 

The researchers partnered with the Commonwealth Fund and the World Innovation Summit for Health to build the framework for the study. Their framework for an ACO included five main elements: 


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  1. A focus on population health.
  2. Use of performance measures.
  3. Support for ongoing, and continuous, improvement.
  4. Care coordination.
  5. Aligned payment and nonfinancial regulations. 

RELATED: Healthcare innovation lessons from around the world 

The three pilots each tackled different healthcare concerns. In Nepal, the focus was on expanding access to and improving primary care, while in the Netherlands, accountable care models were applied to diabetes care. In Germany, the pilot centered on integrating care within an ACO. 

"Transforming healthcare to improve outcomes and use resources efficiently is difficult, and many innovations in care have not yet fulfilled their promise," the researchers said. "The rise in global accountable care activity presents new opportunities to develop the evidence necessary to implement, scale, and sustain these needed innovations in healthcare delivery." 

RELATED: Medicare Shared Savings Program ACOs saved $652M last year 

Examining how ACO models could work abroad also offers lessons for implementing these programs stateside, according to the study. For providers, it highlights the importance of data-sharing for sustained care coordination and alignment between stakeholders, and shows the need for continued focus on systemwide reform. 

Patient-centered, coordinated care also requires "shifting the locus of care" to communities and away from the hospital, which providers should keep in mind, according to the researchers. 

Healthcare policymakers and payer can also take lessons away from the study. They can continue to support providers' shift to patient-centered care by using data, and can build the evidence needed to continue to refine accountable care programs. 

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