Accountable Care Organizations (ACOs) Model

An Accountable Care Organization (ACO) is a system of care that integrates people, information, and resources for patient care activities and creates financial incentives for care coordination. ACOs create financial incentives for healthcare providers to coordinate a patient's care across settings, such as the physician's office, emergency department or hospital, rehabilitation facility, and nursing home. When ACOs meet certain quality measures, the healthcare providers that have met the standards share in the savings. ACO quality measures fall into four domains:

• Patient/caregiver experience
• Care coordination/patient safety
• Preventive health
• At-risk group

ACOs formed by or including Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Critical Access Hospitals (CAHs) must adhere to provisions that are designed to increase the participation of rural providers. Data from the FQHCs and RHCs are used to assign beneficiaries to ACOs in order to measure quality and financial performance under the program.

Examples of Rural ACO Programs

• Headquartered in Duluth, Minnesota, Essentia Health became an accredited ACO by NCQA in 2013. The ACO is comprised of 15 hospitals, 75 clinics, 7 long-term care facilities, 2 assisted living facilities, 4 independent living facilities, 5 ambulatory services, and 1 research institute. Essentia Health serves rural patients in Minnesota, Wisconsin, North Dakota, and Idaho.
• Located in Littleton, New Hampshire, North Country ACO is comprised of four community health centers serving patients throughout rural New Hampshire. All of the ACO participants are part of the North Country Health Consortium.
• Northern Light Health Accountable Care Organization provides integrated care to patients in rural Maine through community care teams that include nurses, licensed social workers, and community health workers.
• Also in Maine, the Community Care Partnership of Maine Accountable Care Organization uses a health information exchange (HIE) to streamline sharing patient information among participating providers.

Considerations for Implementation

There are multiple considerations for implementing an ACO. The costs associated with forming an ACO may present challenges for some small- and medium-sized rural physician practices that have more limited access to capital and infrastructure. Participating in an ACO may benefit rural providers through shared savings. The shared savings can be reinvested, for example, to finance care coordination activities or modernize data infrastructure.

Obtaining permission to share data between healthcare organizations and across state lines can also be a challenge for rural ACOs. It is important to establish formal agreements for data sharing.

To ensure that ACOs provide coordinated care, healthcare providers and other staff must have specific skills, knowledge, and training. Some ACOs have established a role for care coordinators to help monitor high-risk patients. ACOs may also use risk stratification analysis or other tools to identify high-risk patients that require additional support and monitoring. To advance these skills among ACO staff, additional training may be necessary.

Resources to Learn More

Accountable Care and Accountable Care Organizations
Website
Describes ACOs and how they serve to facilitate the coordination of care.
Organization(s): Centers for Medicare and Medicaid Services

AAFP: Accountable Care Organizations
Website
Provides an overview of ACOs and responses to frequently asked questions.
Organization(s):Organization(s): American Academy of Family Physicians

Competition in the Health Care Marketplace: Accountable Care Organizations
Website
Offers information and resources regarding the ACO Antitrust Enforcement Policy Statement. Includes the Federal Register Notice, frequently asked questions, and a summary of activities following issuance of final policy statement.
Organization(s): Organization(s): Federal Trade Commission

Medicare Accountable Care Organizations: Past Performance and Future Directions
Document
Summarizes research findings from ACOs and offers recommendations to strengthen incentives for providers to participate in the ACO model and for patients to obtain services from ACO providers.
Organization(s): Congressional Budget Office
Date: 4/2024