The Impact of Accountable Care: Health Insurers and the Accountable Care Movement

Payers that work collaboratively with providers to deliver high-quality outcomes at a lower cost will also share in changing marketplace opportunities.

The Issue

With the 2010 passage of the Affordable Care Act, the accountable care organization (ACO) model of care has emerged as a payment system reform that emphasizes coordinated care, improved outcomes, and reduced costs. In an ACO, providers not only deliver services, but also accept some financial risk for a defined population, changing the traditional role of payers. An estimated 23.5 million people are now covered under ACO contracts, including 7.8 million covered by Medicare.

Key Findings

Among lessons learned from payers engaged in the accountable care movement:

  • To remain involved as collaborative partners in health care delivery, payers can work with providers by sharing data to improve quality.

  • Payers are acquiring provider systems, consolidating the marketplace while continuing to offer tiered networks and consumer choice.

  • ACOs will continue to shift risk to providers who may share in cost savings or losses, or receive bonuses for a population’s health performance.


Payers that resist value-based payments and are not engaged in the accountable care movement risk further market share disruptions and forgo the opportunity to share in new networks.

About the Study

This issue brief, one of six in a series called “The Impact of Accountable Care,” was prepared by Blue Cross Blue Shield Association and Leavitt Partners with RWJF support.