How "accountable" are accountable care organizations?

Area of Science:

• Healthcare Management
• Health Policy
• Organizational Behavior

Background:

• Accountable Care Organizations (ACOs) were established under the Affordable Care Act (ACA) to improve care quality and reduce costs.
• A significant challenge for ACOs is developing effective governance and accountability mechanisms to meet these dual aims.

Purpose of the Study:

• To explore how newly formed ACOs establish governance structures and accountability.
• Focus on collaborative accountability and shared governance models within ACOs.

Main Methods:

• Conducted four case studies of ACOs across the United States.
• Gathered data through 34 semistructured interviews, 9 meeting observations, and document analysis in 2012.

Main Results:

• Limited evidence of physicians being collectively held accountable, impacting behavioral change.
• ACO leaders possess various tools to influence physician behavior.
• Identifying optimal governance and accountability structures remains a key challenge for achieving accountable care goals.

Conclusions:

• Governance and accountability must be customized to each ACO's unique composition and development stage.
• Aligning performance measures and thresholds across payers is essential to avoid undue burdens.
• Credible, transparent data is critical for effective accountability.