How safety-net ACOs can achieve the Triple Aim

Safety-net accountable care organizations (ACOs) can deliver care that achieves healthcare's Triple Aim of better care, improved health and reduced costs, according to a blog post from Health Affairs.

Researchers spent two years conducting in-person site visits and telephone interviews with more than 60 safety-net healthcare leaders and state officials in 14 states: Alabama, California, Colorado, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Jersey, North Carolina, Oregon, Pennsylvania, Vermont and Washington. They made several observations. Here are three of them:

  1. State policies play a major role in safety-net ACO formation: Several states actively created incentives to form safety-net ACOs, according to the research. For example, Massachusetts' Chapter 224 cost-containment legislation requires 80 percent of the state's Medicaid population enroll in risk-based contract by next year. However, safety-net providers in states without state policy guidance pursue ACO activities as well, such as California, where AltaMed, the country's largest independent federally qualified health center, collaborated with safety-net hospitals.

  2. Safety-net ACOs need infrastructure investments: Health Affairs cites the 2013 National ACO Survey, which found organizations will need an average of $4 million in capital to start an ACO, the kind of commitment many safety-net providers cannot make. "Even if ACOs promise long-term shared savings, they still require upfront capital to launch delivery system transformation," the post states.

  3. The full transformation takes time: Many safety-net ACOs start without a clearly-defined governance structure or even the label of ACO, according to the post. This incremental approach means safety-net ACOs often start out participating in ACO-like contracts with shared savings arrangements rather than taking downside risk from the beginning. The aforementioned state policies often promote this gradual approach.

To learn more:
- read the blog post