“This program was pulled together to understand the impact of ACOs on the general insurance marketplace—on costs, on patient access to care, and making sure that ACOs were also considering the needs of vulnerable populations.”—Barbara Leonard, MPH, Technical Advisory Committee member
Dates of Program: December 2011 through May 2016.
Description: In December 2011, the Robert Wood Johnson Foundation launched a national program, Accountable Care Organizations: Testing Their Impact, to learn more about how accountable care organizations (ACOs) are evolving and how they influence the delivery of health care. The number of ACOs has increased from about 100 when the program started to 626 as of May 2014.
In a first round of funding (March 2013–March 2015), RWJF selected four research teams to produce qualitative case studies on ACOs serving the private health insurance market or Medicaid. Researchers are conducting two rounds of site visits, key informant interviews, and, in some cases, focus groups with patients and families. In a second funding round, RWJF will commission papers on predefined topics from subject matter experts.
ACOs have the potential to “move us toward that Culture of Health vision” because they are “designed to reduce waste, reduce duplication, increase care coordination, and align incentives within health care systems—in turn making care better and more affordable.”—RWJF Program Officer Andrea Ducas, MPH
There is considerable variability among ACOs with respect to size, provider composition, patient population, and contracting arrangements.
The development of ACO arrangements for the safety net and Medicaid populations lags behind those for commercial and Medicare payer population and hospital involvement in ACO arrangements lags behind that of purchasers, payers, and physician organizations.
Most patients do not know they are in an accountable care organization, although they value providers having access to their health records and having a more integrated health care experience.
Safety-net ACOs are developing strategies to manage the social needs that influence health—such as safe housing, access to transportation and healthy food, and employment opportunities.
It is difficult to find cost savings in the commercial health insurance arena because the patient population tends to be relatively healthy, so ACOs tightly manage the referrals of their patients to specialists.