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Private sector accountable care organization development: a qualitative study.

Ann Scheck McAlearney1, Brian Hilligoss, Paula H Song

  • 1Department of Family Medicine, College of Medicine, The Ohio State University, 273 Northwood and High Bldg, 2231 North High St, Columbus, OH 43201.

The American Journal of Managed Care
|April 8, 2017
PubMed
Summary
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Private sector accountable care organizations (ACOs) are driven by quality improvement and anticipated payment reform. Consumers are often unaware of ACOs, while success hinges on provider engagement and strong leadership for value-based care.

Area of Science:

  • Healthcare Management
  • Health Services Research
  • Value-Based Care

Background:

  • Accountable Care Organizations (ACOs) are emerging in the private sector.
  • Understanding their development, consumer perceptions, and success factors is crucial.

Purpose of the Study:

  • To explore private sector ACO development motivations.
  • To examine consumer and stakeholder perspectives on ACOs.
  • To identify critical success factors for ACOs.

Main Methods:

  • Conducted comprehensive case studies of 4 full-risk private sector ACOs.
  • Performed 68 key informant interviews and 5 consumer focus groups.
  • Collected organizational documents and conducted telephone interviews.

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Main Results:

  • Key motivators include improving quality/efficiency, population health, and anticipating payment reform.
  • Consumers were largely unaware of receiving care from ACOs.
  • Success factors include provider engagement, leadership, IT infrastructure, and risk management experience.

Conclusions:

  • Private sector ACOs strategically position themselves for evolving healthcare delivery and reimbursement policies.
  • Understanding mature ACO success factors can guide other organizations in enhancing value and advancing their ACO journey.