Policy, Practice or Research Impacts:
We expect the project to contribute significantly to the understanding of how ACO formation is progressing nationally along three major fronts. First, the annual survey intends to document the extent and depth of ACO formation in the private sector, illustrate how ACO formation varies across states and regions, and describe how regional characteristics may influence ACO formation, drawing on data from the Dartmouth Atlas of Health Care. This will help highlight whether ACOs are more likely to emerge in high or low cost regions and whether the presence of regional initiatives such as the Beacon program, Aligning Forces for Quality or other multistakeholder initiatives influence ACO formation. Second, the survey results will describe the characteristics of emerging ACOs and how ACOs already in existence evolve over the 3 years of the project. Third, the follow-up in-depth qualitative interviews will advance our understanding of the full range of factors contributing to the successful formation of ACOs —and specifically to the formation of multi-payer ACOs, providing useful insights to health system leaders and policy makers. Finally, drawing on the combined data from the NSPO and the proposed ACO surveys, we aim to advance our understanding of what characteristics of physician groups predict successful ACO formation. Looking forward, this study will provide the foundation for future work that will allow us to compare ACO performance and identify what factors predict better performance on cost and quality, drawing on Medicare claims data at community and, ideally, ACO levels.
Principal Investigators:
Elliott S. Fisher, MD, MPH; Valerie Lewis, PhD; Stephen Shortell, PhD, MPH, MBA