title: Factors That Distinguish High-Performing Accountable Care Organizations in the Medicare Shared Savings Program.
abstract: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program.
  
  
  
  Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs.
  
  
  
  Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance.
  
  
  
  A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed.
  
  
  
  Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators.
  
  
  
  Shorter interventions can improve ACO performance-use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician-hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance.
authors.affiliation: New York University Wagner School of Public Service, New York, NY.
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Aunno
authors.affiliation: New York University Wagner School of Public Service, New York, NY.
authors.forename: Lauren
authors.initials: L
authors.lastname: Broffman
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Sparer
authors.affiliation: New York University School of Medicine and New York University Wagner School of Public Service, New York, NY.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Kumar
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration* / Q000592:standards; D003299:Cooperative Behavior; D017046:Cost Savings; D006123:Group Practice / Q000458:organization & administration; D005102:Health Expenditures; D006302:Health Services Research; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D007857:Leadership; D006278:Medicare; D015279:Organizational Culture; D058996:Quality Improvement / Q000458:organization & administration; D012111:Residence Characteristics; D014481:United States
keywords: Accountable care organizations; Patient Protection and Affordable Care Act; physician leadership