ACO contracting with private and public payers: a baseline comparative analysis.

Area of Science:

• Healthcare economics
• Health services research
• Value-based care models

Background:

• Accountable Care Organization (ACO) models are increasingly adopted by private insurers and government entities.
• Limited understanding exists regarding the prevalence and structural characteristics of private payer ACO contracts compared to public ones.

Purpose of the Study:

• To analyze the prevalence of private payer ACO contracts.
• To characterize the structures of private payer ACO contracts.
• To compare private ACO contracts with public ACO contracts.

Main Methods:

• Cross-sectional analysis of the National Survey of Accountable Care Organizations (n=173).
• Examination of ACO contracts with both public and private payers.
• Detailed analysis of private payer contract characteristics.

Main Results:

• Approximately half of ACOs held private payer contracts.
• Upside-only shared savings was the most common private contract model (41%), but most private contracts (56%) incorporated downside risk.
• The majority of private contracts linked shared savings to quality performance (79%) and often included upfront payments like care management (56%).
• Organizations with private ACO contracts were larger and more advanced than those with only public contracts.

Conclusions:

• Commercial ACO contracts, while less prevalent than public ones, are more likely to feature downside financial risk and include upfront payments.
• Private payer ACO contracts may indicate a more mature or complex organizational structure.