ACOs Widespread, Yet Challenged

Joe Cantlupe, for HealthLeaders Media , June 18, 2013

Two of the pioneering forces behind accountable care organizations say the model is gaining significance as it proliferates across the country, even though there are concerns over lack of uniformity in performance measures.


Elliot Fisher, MD, MPH

While the number of Accountable Care Organizations is increasing dramatically across the United States and showing quality and efficiency successes, many providers are struggling to implement the programs, often due to the wide range of required performance measures.

That was the message delivered this week by Elliot Fisher, MD, MPH, director of The Dartmouth Institute for Health Policy and Clinical Practice, and Mark McClellan, MD, PhD, former administrator of the Centers for Medicare & Medicaid Services, and a commissioner of the Food and Drug Administration. Fisher and McClellan are two of the developers of the ACO model, who spoke at an Accountable Care Organization Summit in Washington D.C. The event focused on payment reform.

Indeed, ACOs are multiplying exponentially, with more than 390 today in every region of the country, working with commercial health plans, Medicaid and states, compared to only about a dozen four years ago, said McClellan, senior fellow of the Brookings Institution and director of the Engelberg Center for Health Care Reform there.

Brookings and Dartmouth have estimated that at least 14% of the American population is now involved in ACO care—about one in seven Americans, McClellan said.

"It's hard to keep up with exactly how large the population is," McClellan said. "The numbers are growing rapidly." They involve hospitals, private insurers, the general population or Medicare beneficiaries.

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