Health Affairs shares emerging lessons for ACO implementation
A new report in Health Affairs explored the lessons learned from accountable care organizations (ACOs) across the globe.
The researchers said many innovations have yet to fulfill promises of improving outcomes and efficiently using resources.
ACOs present “new opportunities to develop the evidence necessary to implement, scale and sustain these needed innovations in healthcare delivery.” ACO results in the U.S. “demonstrate quality improvements with some overall modest reductions in health system costs,” according to the report.
Accountable care innovations differ, but the researchers highlighted common elements and challenges that ACOs face. The researchers, led by Mark McClellan, director of the Robert J. Margolis Center for Health Policy at Duke University and CMS administrator during the George W. Bush Administration, said providers, payers and policymakers can learn from the ACOs’ experiences and rework models and policies to improve population health outcomes and improve efficiencies.
ACOs are cropping up across the world. There were nearly 1,000 in the U.S. as of March, but changes to payments systems are “challenging and complex to implement, requiring significant policy and delivery changes,” they wrote.
The researchers said evidence about how to implement ACOs remains limited despite the global interest on the topic. They applied a comprehensive framework for assessing ACOs to three reforms outside the U.S. — Germany, Nepal and the Netherlands — and offered lessons to help future implementation and evaluation of ACOs.
They broke them down into three different approaches to accountable care reforms: innovative primary care, problem-focused care and comprehensive population care.
Their findings show that “in addition to designing policy reforms effectively, success requires providers to develop new patient-focused competencies.” They added that a global accountable care learning network can help organizations build on existing regional and country-level efforts.
“Such a network could also strengthen organizational capabilities by providing peer engagement and practical examples of how to implement accountable care and link organizations to others undertaking similar care transformation efforts. The need for better person-centered models of care is urgent, and the opportunities for innovation are greater than ever,” wrote the researchers.
Though ACOs have been a mixed bag, there have been notable successes. A recent report showed that 11 of 18 Next Generation ACOs earned savings in 2016. Also, a recent analysis from the HHS Office of Inspector General focusing on the first three years of the Medicare Shared Savings Program showed that most ACOs in the program reduced spending and improved care quality.
Another ACO that has shown promise involves Banner Health and Aetna. The two healthcare companies have worked together for more than five years on an ACO. The program resulted in nearly $10 million in savings, a 24% drop in avoidable surgical admissions and increased generic drug prescribing rates by 4%, according to Aetna.