TY - JOUR
AU - Valerie A. Lewis
AU - Karen Schoenherr
AU - Taressa Fraze
AU - Aleen Cunningham
A1 - 
AB - BACKGROUND: Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. PURPOSE: The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts. METHODS: We conducted semistructured interviews between July and December 2013. Our sample includes ACOs that began performance contracts in 2012, including Medicare Shared Savings Program and Pioneer participants, stratified across key factors. In total, we conducted interviews with executives from 30 ACOs. Iterative qualitative analysis identified common patterns and themes. RESULTS: ACOs in the first year of performance contracts are commonly focusing on four areas: first, transforming primary care through increased access and team-based care; second, reducing avoidable emergency department use; third, strengthening practice-based care management; and fourth, developing new boundary spanner roles and activities. ACOs were doing little around transforming specialty care, acute and postacute care, or standardizing care across practices during the first 18 months of ACO performance contracts. PRACTICE IMPLICATIONS: Results suggest that cost reductions associated with ACOs in the first years of contracts may be related to primary care. Although in the long term many hope ACOs will achieve coordination across a wide array of care settings and providers, in the short term providers under ACO contracts are focused largely on primary care-related strategies. Our work provides a template of the common areas of clinical activity in the first years of ACO contracts, which may be informative to providers considering becoming an ACO. Further research will be needed to understand how these strategies are associated with performance.
AD - Valerie A. Lewis, PhD, is Assistant Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, New Hampshire. Karen Schoenherr, AB, is Manager, Pediatric Behavioral Health Integration, Codman Square Health Center, Boston, Massachusetts. Taressa Fraze, PhD, is Research Scientist, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, New Hampshire. Aleen Cunningham, MIA, is Director of Operations, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, New Hampshire.
BT - Health care management review
C5 - Education & Workforce; Financing & Sustainability
CP - 2
CY - United States
DO - 10.1097/HMR.0000000000000141
IS - 2
JF - Health care management review
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. PURPOSE: The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts. METHODS: We conducted semistructured interviews between July and December 2013. Our sample includes ACOs that began performance contracts in 2012, including Medicare Shared Savings Program and Pioneer participants, stratified across key factors. In total, we conducted interviews with executives from 30 ACOs. Iterative qualitative analysis identified common patterns and themes. RESULTS: ACOs in the first year of performance contracts are commonly focusing on four areas: first, transforming primary care through increased access and team-based care; second, reducing avoidable emergency department use; third, strengthening practice-based care management; and fourth, developing new boundary spanner roles and activities. ACOs were doing little around transforming specialty care, acute and postacute care, or standardizing care across practices during the first 18 months of ACO performance contracts. PRACTICE IMPLICATIONS: Results suggest that cost reductions associated with ACOs in the first years of contracts may be related to primary care. Although in the long term many hope ACOs will achieve coordination across a wide array of care settings and providers, in the short term providers under ACO contracts are focused largely on primary care-related strategies. Our work provides a template of the common areas of clinical activity in the first years of ACO contracts, which may be informative to providers considering becoming an ACO. Further research will be needed to understand how these strategies are associated with performance.
PP - United States
PY - 2019
SN - 1550-5030; 0361-6274
SP - 127
EP - 136
EP - 
T1 - Clinical coordination in accountable care organizations: A qualitative study
T2 - Health care management review
TI - Clinical coordination in accountable care organizations: A qualitative study
U1 - Education & Workforce; Financing & Sustainability
U2 - 27926614
U3 - 10.1097/HMR.0000000000000141
VL - 44
VO - 1550-5030; 0361-6274
Y1 - 2019
Y2 - Apr/Jun
ER -