Clinical coordination in accountable care organizations: A qualitative study

Area of Science:

• Healthcare Management
• Health Services Research
• Quality Improvement

Background:

• Accountable care organizations (ACOs) are a prevalent payment and delivery model.
• Limited empirical research exists on ACO strategies for care transformation and cost reduction.
• Understanding ACO clinical efforts is crucial for interpreting performance and identifying areas of care transformation.

Purpose of the Study:

• To investigate the clinical care transformation efforts undertaken by ACOs within the initial 18 months of their contracts.
• To identify specific strategies employed by ACOs to modify care delivery and manage costs.

Main Methods:

• Conducted semistructured interviews with executives from 30 ACOs between July and December 2013.
• Included Medicare Shared Savings Program and Pioneer ACOs initiated in 2012.
• Utilized iterative qualitative analysis to identify common themes and patterns in ACO strategies.

Main Results:

• ACOs concentrated on four primary areas: transforming primary care access and team-based models, reducing avoidable emergency department visits, enhancing practice-based care management, and creating new boundary spanner roles.
• Minimal efforts were observed in transforming specialty care, acute/post-acute care, or standardizing care across practices during this period.
• Initial cost reductions may be linked to these primary care-focused initiatives.

Conclusions:

• Early ACO cost savings appear associated with primary care-centric strategies.
• While long-term goals include broad care coordination, initial ACO focus is on primary care improvements.
• This study offers a framework of common early ACO clinical activities, valuable for organizations considering ACO participation.