Elements of the Accountable Care Organization (ACO)

By Holly Hayes

Marc Bard, MD and Mike Nugent, authors of “Accountable Care Organization, Your Guide to Strategy, Design and Implementation” provide a list of elements common to most ACOs. As described in our previous post , there is still a great deal of ambiguity about the definition of an ACO. The American Hospital Association (AHA) has developed a list of key questions (see below) to ask in the development of an ACO.

Bard and Nugent provide this set of attributes that will be common to most ACOs:

1. Effective, collaborative, enlightened leadership made up of both physicians and professional administrators
2. A culture that supports clinical and operational integration, care redesign, operating efficiency, innovation, and systemness
3. A medical home model for primary care providers able to provide care management, coordination, integration, and patient navigation
4. Comprehensive patient registries to identify high-risk patients and offer services to mitigate risk
5. A broad array of clinical specialists within or in relationship with the ACO
6. One or more acute care hospitals, including associated ambulatory care sites, even though this is not required in the legislation
7. Affiliations, partnerships, joint ventures, or joint operating agreements with subacute care facilities with well-developed management that links and coordinates care across settings
8. Medical risk-management functions that have previously been the purview of payers
9. Supportive compensation, incentive, and reward systems that align with what the market values and is willing to pay for
10. Systems and processes to encourage, manage, and reward patient “stickiness” – the propensity of patients to choose to say within the system for all their care.

The AHA in their June 2010 Accountable Care Organizations AHA Research Synthesis Report list the following key questions to consider in the development and implementation of an ACO:

1. What are the key competencies required of ACOs?
2. How will ACOs address physician barriers to integration?
3. What are the legal and regulatory barriers to effective ACO implementation?
4. How can ACOs maintain patient satisfaction and engagement?
5. How will quality benchmarks be established?
6. How will savings be shared among ACOs?

Future posts on the development of the ACO will examine the relationships between physicians and other physicians and hospitals and physicians in the development of a successful ACO. We welcome your comments.

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Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at holly@karlbayer.com.