ACO Affiliated Hospitals Increase Implementation of Care Coordination Strategies

Hospitals affiliated with Accountable Care Organizations (ACOs) may have a greater capacity to collaborate with providers across the care continuum to coordinate care, due to formal risk sharing and payment arrangements. However, little is known about the extent to which ACO affiliated hospitals implement care coordination strategies.

To compare the implementation of care coordination strategies between ACO affiliated hospitals (n=269) and unaffiliated hospitals (n=502) and examine whether the implementation of care coordination strategies varies by hospital payment model types.

We constructed a care coordination index (CCI) comprised of 12 indicators that describe evidence-based care coordination strategies. Each indicator was scored on a 5-point Likert scale from 1="not used at all" to 5="used widely" by qualified representatives from each hospital. The CCI aggregates scores from each of the 12 individual indicators to a single summary score for each hospital, with a score of 12 corresponding to the lowest and 60 the highest use of care coordination strategies.

We used state-fixed effects multivariable linear regression models to estimate the relationship between ACO affiliation, payment model type, and the use care coordination strategies.

We found ACO affiliated hospitals reported greater use of care coordination strategies compared to unaffiliated hospitals. Fee-for-service shared savings and partial or global capitation payment models were associated with a greater use of care coordination strategies among ACO affiliated hospitals.

Our findings suggest ACO affiliation and multiple payment model types are associated with the increased use of care coordination strategies.