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The role primary care physicians play in ensuring ACO success

Published Date
Author Leona Rajaee

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Accountable care organizations (ACOs) are formed by independent physicians who share a common goal of giving “coordinated high quality care to their Medicare patients.” The Centers for Medicare & Medicaid Services (CMS) further explains that “When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.”

What factors impact the success of the ACO? How do those independent physicians play a role? A study published in Health Affairs indicates that physicians “are the crux of the ACO itself,” according to Dr. John Hsu, lead author of the study.

The key to an ACO’s success appears to lie in the physician’s attitude toward the organization, its patients, and its payer. Dr. Hsu further explained that some of the ACOs in his study were “cherry picking” low-risk patients and that there were actually modest financial incentives even among the successful organizations. According to Dr. Hsu, “’the key point is that the physician played a central role,’ because a physician’s participation in an ACO can heavily influence its financial and quality outcomes.”

A more recent report in Health Payer Intelligence, however, indicated that ACOs have “gained traction over the last year as payers and providers begin to share the same viewpoints on the benefits of value-based care.” Provider attitudes toward the ACO and its success are becoming more positive and the trend is leaning toward more ACO agreements among independent physicians. The main challenge seems to getting providers and payers to agree on definitions of value and of quality measurement.

With the recent shift toward cooperation and coordination, however, Jeff Hulburt, CEO of Beth Israel Deaconess Care Organization (BIDCO), has indicated that “2018 should be a year in which the ACO environment continues to mature, even if progress is likely to happen slowly” in regard to policy debates at the federal level.