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ACOs: Latest Count and a Structural Taxonomy

Leavitt Partners has released two new reports – one with the latest numbers on the growth and dispersion of accountable care organizations and the second presenting a taxonomy for classifying the different types of ACOs.

Here are some of their findings on ACO growth as of May 2014:

  • There are 626 ACOs identified in the US: 329 with government contracts, 210 with commercial contracts, 74 with both government and commercial contracts, and 13 with no contract details
  • An estimated 20.5 million lives are covered by ACOs
  • Payers with the largest share of commercial ACO contracts include Cigna [19%], Aetna [9.1%], and United [4%]
  • ACO growth continues to be focused in dense population areas
  • Utah, Colorado, and Oregon have the maturest Medicaid ACO programs

While ACOs have similar aims, their structure, ownership, and patient care focus differ. To help in researching and evaluating ACOs, Leavitt Partners has developed a taxonomy for classifying them into six structural types:

  1. Full spectrum integrated
  2. Independent physician group
  3. Physician group allliance
  4. Expanded physician group
  5. Independent hospitals
  6. Hospital alliance

The integration, differentiation, and centralization of each ACO type are discussed. Integration reflects the types of patient care directly provided by the ACO  and excludes any care contracted to other providers by the ACO. Integration ranges from outpatient to inpatient to full spectrum. Differentiation is based on the range of services spanning primary through highly specialized care. Centralization deals with the level of decision making, with 2 general categories – single owner and multiple owner.

The opportunities and challenges of the six types of ACOs are also addressed in the report.

Sources:

Peterson M and others. Growth and dispersion of accountable care organizations: June 2014 update. Leavitt Partners, June 2014. http://leavittpartners.com/aco-publications/  [free registration required to view]

Muhlestein D and others. A taxonomy of accountable care organizations: different approaches to achieve the triple aim. Leavitt Partners, June 2014. http://leavittpartners.com/aco-publications/ [free registration required to view]

Related source:

AHA survey of care systems and payment [Excel dataset]. Health Forum, an American Hospital Association affiliate, May 2014. [Hospital-specific survey responses detailing their care coordination function, new payment models, accountable care, and other new systems of care.] Available for purchase/download at http://www.ahadataviewer.com/quickreport/. For more information, call 1-866-375-3633 or email ahadatainfo@healthforum.com.

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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