title: Do accountable care organizations (ACOs) help or hinder primary care physicians' ability to deliver high-quality care?
abstract: BACKGROUND
  Many view advanced primary care models such as the patient-centered medical home as foundational for accountable care organizations (ACOs), but it remains unclear how these two delivery reforms are complementary and how they may produce conflict. The objective of this study was to identify how joining an ACO could help or hinder a primary care practice's efforts to deliver high-quality care.
  
  
  METHODS
  This qualitative study involved interviews with a purposive sample of 32 early adopters of advanced primary care and/or ACO models, drawn from across the U.S. and conducted in mid-2014. Interview notes were coded using qualitative data analysis software, permitting topic-specific queries which were then summarized.
  
  
  RESULTS
  Respondents perceived many potential benefits of joining an ACO, including care coordination staff, data analytics, and improved communication with other providers. However, respondents were also concerned about added "bureaucratic" requirements, referral restrictions, and a potential inability to recoup investments in practice improvements.
  
  
  CONCLUSIONS
  Interviewees generally thought joining an ACO could complement a practice's efforts to deliver high-quality care, yet noted some concerns that could undermine these synergies. Both the advantages and disadvantages of joining an ACO seemed exacerbated for small practices, since they are most likely to benefit from additional resources yet are most likely to chafe under added bureaucratic requirements.
  
  
  CONCLUSIONS
  Our identification of the potential pros and cons of joining an ACO may help providers identify areas to examine when weighing whether to enter into such an arrangement, and may help ACOs identify potential areas for improvement.
authors.affiliation: The Urban Institute, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berenson
authors.affiliation: The Urban Institute, United States. Electronic address: rburton@urban.org.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Burton
authors.affiliation: Emory School of Medicine, United States.
authors.forename: Megan
authors.initials: M
authors.lastname: McGrath
mesh_terms: D060866:Accountable Care Organizations / Q000592:standards*; D001291:Attitude of Health Personnel; D006801:Humans; D007407:Interviews as Topic; D018802:Patient-Centered Care / Q000592:standards*; D058007:Physicians, Primary Care; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*; D014481:United States
keywords: Accountable care organization; Health care reform; Interviews; Patient-centered medical home; Primary care; Qualitative