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Projected Growth of Accountable Care Organizations

According to a new Leavitt Partners report, the number of accountable care organizations had grown to 782 by December 2015, covering 23 million lives.

What does future growth of ACOs look like? To find out, Leavitt staff made projections based on 4 different scenarios. In a baseline scenario that seemed most likely under current conditions, ACO coverage would reach 105 million people by 2020, but under ideal conditions, that number could reach 176 million lives [over half the population] in the next five years.

There’s been strong government support, including incentives and penalties, for accountable care organizations, but the future growth of ACOs remains unclear. That’s because the concept is still fairly new, and early results from ACOs so far have been mixed.

Despite the wide variation in growth projections for the four scenarios presented, the number of ACO covered lives grows in the five years ahead under each scenario.

Source: Muhlestein D and others. Projected growth of accountable care organizations. Leavitt Partners, Dec. 2015. http://leavittpartners.com/2015/12/projected-growth-of-accountable-care-organizations/ [free registration required to view]

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

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.


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

Updated Count on Number of Accountable Care Organizations

See this post for a later update

There were 488 ACOs by the end of July 2013, more than double the count from June 2012, according to an updated report from Leavitt Partners. The report also indicates:

  • All 50 states now have a segment of their population covered by an ACO.
  • 253 of the ACOs — just over half — are Medicare-contracted.
  • No single model has emerged as the most successful.

Four examples of ACO models are briefly highlighted in the report — a small physician group ACO, a hospital-led ACO, a hospital-physician group ACO, and a Medicaid ACO.

Source: Petersen M and others. Growth and dispersion of accountable care organizations: August 2013 update. Leavitt Partners, Aug. 2013. http://leavittpartners.com/aco-consulting/ [free registration required to view]

Related post: https://aharesourcecenter.wordpress.com/2013/03/21/continued-growth-of-public-and-private-accountable-care-organizations/

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

Continued Growth of Public and Private Accountable Care Organizations

See also updated post at https://aharesourcecenter.wordpress.com/2013/08/21/updated-count-on-number-of-accountable-care-organizations/

There were 428 total accountable care organizations in the US as of January 10, 2013, according to Leavitt Partners’ Center for Accountable Care Intelligence. Every state but Delaware had at least one ACO. This count includes both Medicare and private ACOs.

The Center also reports that physician group-led ACOs increased the most over the past year and are now more numerous, though generally smaller, than hospital-run ACOs. Insurers or community-based groups sponsor some ACOs as well, but there are fewer of them.

While Medicare ACOs have similar structures, the private ACOs have a wider range of payment models – full or partial capitation, bundled payments, retainer agreements, in-kind services and subsidies, and pay-for-performance incentives.

Source: Muhlestein D. Continued growth of public and private accountable care organizations. Health Affairs blog, Feb. 19, 2013. http://healthaffairs.org/blog/2013/02/19/continued-growth-of-public-and-private-accountable-care-organizations/

Earlier post on ACO data from Leavitt Partners: https://aharesourcecenter.wordpress.com/2012/06/15/2012-update-on-growth-and-dispersion-of-acos/

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

2012 Update on Growth and Dispersion of ACOs

Leavitt Partners is out with new numbers on the growth and distribution of accountable care organizations in the past year.  The firm reports there were 221 ACOs identified through May 2012. Sponsoring organization headquarters were hospital systems in 118 of the ACOs, physician groups in 70, insurers for 29, and community-based groups for 4. However, ACOs can vary multiple ways in structure. Leavitt Partners has classified ACOs into 4 categories with the percentage each currently represents of the total:

  • Single-provider [usually an integrated delivery system]:  67%
  • Multiple-provider [such as a hospital and physician organization partnership]: 19%
  • Insurer: 8%
  • Insurer-provider [equal partnership]: 6%

There are ACOs in 45 states, but most are concentrated in urban areas. The Deep South and Appalachia continue to see only limited ACO development compared to other regions.

The report does not list the 221 individual ACOs identified.

Source: Muhletein D and others. Growth and disperson of accountable care organizations: June 2012 update. Leavitt Partners, June 2012. http://leavittpartners.com/wp-content/uploads/2012/06/Growth-and-Dispersion-of-ACOs-June-2012-Update2.pdf

See updated statistics at https://aharesourcecenter.wordpress.com/2013/03/21/continued-growth-of-public-and-private-accountable-care-organizations/

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