4 questions to predict whether ACOs can succeed

Accountable care organizations are widespread throughout the healthcare industry and many experts hope they can significantly help improve quality care while driving down costs, especially as federal officials predict rising spending growth for the next several years.

However, it's still uncertain whether ACOs can meet such high expectations. To help understand ACOs' capacity for creating change, the Kaiser Permanente Institute for Health Policy and the Commonwealth Fund posed several questions to key healthcare leaders. Based on their responses, six themes emerged, reported Healthcare Finance News. We summarize four of those themes below.

1. What do ACOs look like today?

Although all ACOs aim to improve care, the arrangements employ a variety of models. To truly estimate whether ACOs can succeed in lowering costs and boosting quality, the article states that the different ACO characteristics, including how they differ in size, governance and organization, must be understood.

2. Can ACOs' financial incentives change provider behavior?

Another central goal for ACOs is to help the industry transition toward delivering high-value care. But it's unclear whether ACOs' financial incentives sufficiently compel providers to change how they deliver care. A study released this summer, for example, showed that hospitals participating in a pay-for-performance program didn't improve conditions explicitly linked to incentives, FierceHealthPayer reported. What's more, doctors and hospitals have different motivating factors and business models, which impact whether ACOs can actually affect change. For example, physician organizations can reinvent themselves quite nimbly, while it's much harder for a hospital to reinvent its business model, HFN noted.

3. Will ACOs successfully engage their patients?

Many healthcare organizations attempt to engage patients, as FierceHealthPayer previously reported, but it's unclear whether ACOs can achieve high patient engagement. In fact, since most patients don't even know they're enrolled in an ACO, the care delivery models face an uphill battle in engaging consumers. "ACOs tout that they are the vanguard for [patient-centered care]," Sam Lin, medical affairs consultant for the American Medical Group Association, told HFN. "That's a tall order, given we are very protective of our autonomy as providers and payers… [I]s this cultural shift going to occur and actually become ingrained?"

4. Can ACOs integrate with other types of caregivers?

Since ACOs aren't the only care model seeking to initiate change, providers participating in them must be able to work collaboratively with other models, such as patient-centered medical homes and community-based health teams. In fact, medical homes are more likely to improve quality of care and reduce costs when they're coupled with other value-based insurance designs like ACOs, FierceHealthPayer reported previously. They also must coordinate with different types of caregivers, including social workers, behavioral health specialists and long-term care providers, so they can meet a wide range of patients' needs, HFN noted.

To learn more:
- read the HFN article