title: Private sector accountable care organization development: a qualitative study.
abstract: OBJECTIVE
  To explore accountable care organizations (ACOs) as they develop in the private sector, including their motivation for development, perspectives from consumers regarding these emerging ACOs, and the critical success factors associated with ACO development.
  
  
  METHODS
  Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers.
  
  
  METHODS
  Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study ACOs.
  
  
  RESULTS
  We found 3 main motivators for private sector ACO development: 1) opportunity to improve quality and efficiency, 2) potential to improve population health, and 3) belief that payment reform is inevitable. With respect to consumer perspectives, consumers were unaware they received care from an ACO. From the perspectives of ACO stakeholders, these ACOs noted that they prefer to focus on patients' relationships with providers and typically do not emphasize the ACO name or entity. Critical success factors for private sector ACO development included provider engagement, strategic buy-in, prior experience managing risk, IT infrastructure, and leadership, all meant to shift the culture to a focus on value instead of volume.
  
  
  CONCLUSIONS
  These organizations perceived that pursuing an accountable care strategy allowed them to respond to policy changes anticipated to impact the way healthcare is delivered and reimbursed. Increased understanding of factors that have been important for more mature private sector ACOs may help other healthcare organizations as they strive to enhance value and advance in their ACO journeys.
authors.affiliation: Department of Family Medicine, College of Medicine, The Ohio State University, 273 Northwood and High Bldg, 2231 North High St, Columbus, OH 43201. E-mail: Ann.McAlearney@osumc.edu.
authors.forename: Ann
authors.initials: A
authors.lastname: Scheck McAlearney
authors.forename: Brian
authors.initials: B
authors.lastname: Hilligoss
authors.forename: Paula H
authors.initials: PH
authors.lastname: Song
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration*; D017598:Efficiency, Organizational; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D017149:Private Sector; D036301:Qualitative Research; D058996:Quality Improvement; D014481:United States