Organizations are interested in ACOs for a variety of reasons: to engage physicians, because of concerns that providers are carrying more risk, to compete in the market, to provide more resources for clinical integration, and value-based purchasing. However, Slattery cautions that the focus should be achieving the triple aim of healthcare—improve the care experience, improve population health, and reduce the cost of care.
"If you do things right, then these things will happen. You'll have engaged physicians and you'll be able to value-base services, but these are only by-products of achieving the triple aim."
Look for ACO components to include care coordinators, medical homes, pay for performance, and clinical pathways, according to about 70% or more of organizations planning to be part of an ACO. Only 45%, however, listed disease registry as a component. That relatively low level of interest is surprising because much of the success of an ACO depends on the ability to measure patient outcomes. The disease registry provides the transparency that is often viewed as critical to that effort.
Money, patient accountability, and physician resistance are identified as potential stumbling blocks for ACOs. Some 67% of respondents rate as high the potential for the financial risk of inadequate payment rates to disrupt the success of organization's ACO. Providers have long lamented that healthcare reform requires accountability of everyone except the patient, and 54% of respondents said patient accountability has a somewhat high or high potential to disrupt the success of an ACO. Some 53% rate physician resistance as having a similar effect.