title: ACOs Holding Commercial Contracts Are Larger And More Efficient Than Noncommercial ACOs.
abstract: Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variation in their performance. Using data from national surveys of 399 ACOs, we examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid). Commercial ACOs were significantly larger and more integrated with hospitals, and had lower benchmark expenditures and higher quality scores, compared to noncommercial ACOs. Among all of the ACOs, there was low uptake of quality and efficiency activities. However, commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods than did noncommercial ACOs. Few ACOs reported having high-level performance monitoring capabilities. About two-thirds of the ACOs had established processes for distributing any savings accrued, and these ACOs allocated approximately the same amount of savings to the ACOs themselves, participating member organizations, and physicians. Our findings demonstrate that ACO delivery systems remain at a nascent stage. Structural differences between commercial and noncommercial ACOs are important factors to consider as public policy efforts continue to evolve.
authors.affiliation: David Peiris (dpeiris@hsph.harvard.edu) is a Harkness Fellow at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Peiris
authors.affiliation: Madeleine C. Phipps-Taylor is a director of Allocate Software Ltd., in London, United Kingdom. At the time of this study, she was a 2014-15 Harkness Fellow at the School of Public Health at the University of California, Berkeley.
authors.forename: Madeleine C
authors.initials: MC
authors.lastname: Phipps-Taylor
authors.affiliation: Courtney A. Stachowski is a research project specialist at the Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Stachowski
authors.affiliation: Lee-Sien Kao is an associate at ideas42, in Washington, D.C. At the time of this study, she was a health policy fellow at the Dartmouth Institute for Health Policy and Clinical Practice.
authors.forename: Lee-Sien
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Stephen M. Shortell is the Blue Cross of California Distinguished Professor of Health Policy and Management, a professor of organization behavior, director of the Center for Healthcare Organizational and Innovation Research, and dean emeritus, all at the School of Public Health, University of California, Berkeley.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.affiliation: Valerie A. Lewis is an assistant professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Lewis
authors.affiliation: Meredith B. Rosenthal is a professor of health economics and policy in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health.
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.affiliation: Carrie H. Colla is an associate professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice.
authors.forename: Carrie H
authors.initials: CH
authors.lastname: Colla
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics* / Q000379:methods; D032982:Contracts / Q000191:economics*; D017046:Cost Savings / Q000191:economics*; D005102:Health Expenditures / Q000639:trends; D006761:Hospitals; D006801:Humans; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D011795:Surveys and Questionnaires; D014481:United States
keywords: Health Reform; Organization and Delivery of Care; Quality Of Care