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Accountable Care Organizations: Findings from an AHA Survey

How many hospitals are part of an accountable care organization? How are their ACOs structured, and what types of contracts and risk models are being used? What are the challenges? How are patient engagement, care management, and performance management being handled? Are the ACOs part of an information exchange?

To find answers to these and other questions, the American Hospital Association sent a survey in 2013 to all 4999 community hospitals in the US, and of the 1517 responses received [a representative sample], 309 hospitals [20%] reported they were part of an accountable care organization.

Here are some of the other findings:

  • ACO STRUCTURE:  Two-thirds reported a new legal entity was formed for the ACO, such as an LLC. Governance was most often characterized as either a physician/hospital-led joint venture or as a physician-led ACO. Most [72%] ACOs will centralize their purchasing function.
  • CONTRACTS/RISK MODELS: A commercial payer partnership or a Medicare Shared Savings Program were the most frequently cited shared savings programs pursued. Under Medicare, nearly two-thirds preferred the one-sided risk model, and 89% anticipated engaging in an upside or simple shared savings model.
  • CHALLENGES: The biggest ACO challenges were developing clinical and management information systems and aligning incentives to promote provider productivity.
  • PATIENT ENGAGEMENT/CARE MANAGEMENT: Nearly two-thirds will notify patients that they are attributed to an ACO, and about half of those will allow patients to opt out. Nearly all the ACOs had a systematic process for identifying eligible patients.
  • PERFORMANCE MANAGEMENT: Most ACOs will track multiple types of measures, including quality, utilization, financial, and patient satisfaction. Just over half can track and routinely share these measure with all ACO members.
  • INFORMATION EXCHANGE: Less than half of ACOs are participating in a health information exchange.

The AHA Survey of Care Systems is an ongoing survey to be updated regularly.

Sources:

Accountable care organizations: findings from the Survey of Care Systems and Payment. American Hospital Association, Aug. 2014. http://www.aha.org/content/14/14aug-acocharts.pdf

AHA survey of care systems and payment [database for sale]. Health Forum, an American Hospital Association affiliate, 2014. Description at http://www.ahadataviewer.com/about/AHA-Survey-of-Care-Systems-and-Payment/; Download available for purchase at http://www.ahadataviewer.com/quickreport/

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

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