Accountable care continues to grow

With 600+ public and private accountable care organizations (ACOs) in the U.S., it’s clear that accountable care has taken a stronghold in today’s healthcare environment. And this trend is progressing, according to respondents from Premier's semiannual Outlook survey.

While 32 percent of C-suite survey respondents report they already have an ACO model in place, 48 percent have plans to join or create an ACO in the near future. And only 1/5 of respondents have no plans to create or join an ACO.

If the vast majority are going down the ACO road, what are the drawbacks for the other 20 percent? The answer depends on who you ask. The primary factors include:

• Hospital size
• Lack of perceived value
• Patient population
• Location

Survey respondents in the southeastern U.S. were twice as likely as others to cite patient population or location. Comparatively to respondents in the Northeast/Mid-Atlantic, Midwest and West, those in the Southeast were about half as likely to currently be part of an ACO, and were nearly twice as likely to have plans to join or create an ACO in the near future.

Hospital size and structure also plays a major role.

Since the configuration of an ACO is based on managing patient care across the continuum, it’s no surprise that more than twice as many respondents from IDNs report that their system already has an ACO in place compared to non-IDN respondents.

Payment arrangements and partnerships

An ACO is a model by which providers can coordinate a patient’s care across the continuum. Population health is the framework for helping people maintain good health outside of the healthcare system when possible, or use the right type of care when necessary. Population health needs scale and connectivity, both in terms of data and between the health system and community. Our member health systems are working across these areas to improve population health.

Population health initiatives are aligned to one of several main themes:

• Better connecting patients to the healthcare system (e.g., virtual care/telemedicine, end-of-life care, home health)
• Improving the transparency and practicality of data regarding a patient population (e.g., risk stratification, integrated datasets, patient registries)
• Providing preventive or health maintenance programs (e.g., lifestyle and wellness coaching, community engagement programs)

Almost 50 percent of survey respondents report that they’re dedicating the most resources to payer partnerships to improve population health. In fact, three-quarters of respondents are currently engaged in a payer partnership (whether public or private) with 27 percent engaged in more than 4 payer partnerships.

The most common payment arrangement is upside-only shared savings, followed by bundled payments and capitation. Half as many respondents are participating in shared savings with downside risk compared to those in the upside-only shared savings arrangements. While many health systems are putting more than their toes in the water of value-based care, many are not yet prepared to take on additional penalties for not achieving targets.

All of these initiatives demonstrate the amount of work being done to connect industry partners with the populations they serve to improve health and the system as a whole.

This post first appeared at Action for Better Healthcare.