title: The march to accountable care organizations-how will rural fare?
abstract: OBJECTIVE
  This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs).
  
  
  METHODS
  ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA) makes contracts with ACOs a permanent option under Medicare. This article explores ACA implications, using the literature to describe successful integrated health care organizations that will likely become the first ACOs. Previous research studying rural managed care organizations found rural success stories that can inform the ACO discussion.
  
  
  RESULTS
  Preconditions for success as ACOs include enrolling a minimum number of patients to manage financial risk and implementing medical care policies and programs to improve quality. Rural managed care organizations succeeded because of care management experience, nonprofit status, and strong local leadership focused on improving the health of the population served.
  
  
  CONCLUSIONS
  Rural provider participation in ACOs will require collaboration among rural providers and with larger, often urban, health care systems. Rural providers should strengthen their negotiation capacities by developing rural provider networks, understanding large health system motivations, and adopting best practices in clinical management. Rural communities should generate programs that motivate their populations to achieve and maintain optimum health status. Policy makers should develop rural-relevant ACO-performance measures and provide necessary technical assistance to rural providers and organizations.
authors.affiliation: RUPRI Center for Rural Health Policy Analysis, University of Iowa, Iowa City, Iowa, USA. clintmack@cloudnet.com
authors.forename: A Clinton
authors.initials: AC
authors.lastname: Mackinney
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Mueller
authors.forename: Timothy D
authors.initials: TD
authors.lastname: McBride
mesh_terms: D003299:Cooperative Behavior; D006801:Humans; D018854:Managed Competition / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006278:Medicare / Q000331:legislation & jurisprudence; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D019035:Rural Health Services / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D014481:United States