In today’s changing healthcare environment, provider organizations face intensifying pressure to reduce costs and improve quality of care. To make progress on these divergent goals, healthcare provider organizations, including hospitals and health systems, are developing new ways of integrating with physicians and other clinicians for delivering care to patients. Also many provider organizations are currently exploring the benefits of transitioning to an accountable care enterprise. An Accountable Care Organization (ACO) is the equivalent of a joint venture between physicians, medical groups, clinics, health systems, hospitals and, in many cases, insurance companies. They have come together voluntarily to give coordinated, high quality care to their patients, with the goal of creating efficiencies, reducing costs, decreasing errors, and improving safety.
Under ACOs, decision making is more centralized and controlled. ACOs have significant control over decisions related to formulary, treatments, health IT adoption, sales-rep access, drug sampling policies, new product uptake and more. With so much at stake, service providers must understand how to position themselves in the eyes of the ACOs. Each organization needs to define a unique operating model and structure to support their chosen accountable care strategy.
- Medicare Shared Savings Programs (MSS Programs) are designated to coordinate care for Medicare fee-for-service beneficiaries.
- Commercial ACOs are distinct from Medicare ACOs in that a commercial payer, rather than Medicare, is the entity providing the financial incentives for quality and cost performance to provider organizations.
- Look-Alike ACOs contract with commercial plans in a similar model to other ACOs but do not contract with Medicare.
- Medicaid ACO is a fee for service through Medicaid. In fee-for-service Medicaid, reimbursement rates are set by the state, leaving no room for providers to raise prices. Also known as Accountable Care Collaborative.
- Pioneer ACO is designed for early adopters of coordinated care that take on more risk than the MSS model
The number of physicians, nurse practitioners and physician assistants participating in ACOs exceeds 167,000. As of this writing, there are nearly 250,000 total healthcare providers and business personnel aligned with ACOs. These are the top 30 ACOs ranked in terms of total number of physician affiliations.
|Corporation||Headquarters||State||Facilities||Total Participating Physicians||Type of ACO|
|2||Valley Preferred Aetna||Allentown||PA||490||3,533||Commercial|
|3||Hill Phys/Dignity Health/UCSF Health Net||San Ramon||CA||1,138||3,279||Commercial|
|4||Heritage California ACO||Northridge||CA||1,813||3,099||Pioneer|
|5||Hill Phys/Dignity Health CalPers ACO||San Ramon||CA||1.139||3,081||Commercial|
|6||Indiana University Health ACO Inc.||Indianapolis||IN||567||2,884||MSS Program|
|7||Hill Phys St. Mary’s Med Ctr Saint Francis Memorial Hospital & UCSF Med Ctr Blue Shield||San Francisco||CA||979||2,843||Commercial|
|8||Cleveland Clinic Cigna ACO||Cleveland||OH||372||2,743||Commercial|
|9||Baylor Quality Alliance||Dallas||TX||536||2,376||MSS Program|
|10||Aurora Health Accountable Care Network Aetna||Milwaukee||WI||367||2,188||Commercial|
|11||Montefiore Accountable Care Organization||Bronx||NY||390||2,173||Pioneer|
|13||Carolinas Healthcare System||Charlotte||NC||479||2,075||Commercial|
|14||Mercy Clinic Mercy Hospital Springfield and Mercy Clinic Sprinfield||Chesterfield||MO||492||2,009||MSS Program|
|15||Northwest Metro Alliance||Bloomington||MN||212||1,891||Commercial|
|16||Advocate Physician Partners Accountable Care Inc.||Rolling Meadows||IL||564||1,835||MSS Program|
|17||Heritage Provider Network & Blue Cross ACO||Northridge||CA||1,380||1,825||Look-Alike|
|18||Renaissance Physician Organization||Houston||TX||930||1,776||Pioneer|
|19||Banner Health Network||Mesa||AZ||492||1,769||Pioneer|
|20||Iowa Health Accountable Care LC||West Des Moines||IA||402||1, 682||MSS Program|
|21||Brown & Toland Physicians ACO||San Francisco||CA||520||1,665||Pioneer|
|22||Penn Medicine & Independence Blue Cross||Philadelphia||PA||311||1,614||Commercial|
|23||Valley Preferred Cigna||Allentown||PA||353||1,590||Commercial|
|24||Trinity Pioneer ACO||Fort Dodge||IA||420||1,565||Pioneer|
|25||Brown & Toland Physicians Cigna||San Francisco||CA||383||1,542||Commercial|
|26||Brown & Toland Physicians Blue Shield||San Francisco||CA||383||1,542||Commercial|
|27||OneCare Vermont ACO LLC||Colchester||VT||362||1,540||MSS Program|
|28||Bon Secours Good Helpcare LLC||Marriottsville||MD||461||1,531||MSS Program|
|29||University of Michigan Health System||Ann Arbor||MI||208||1,503||MSS Program|
|30||University Hospitals Cigna||Shaker Heights||OH||327||1500||
Healthcare is transforming and ACOs are dramatically expanding. Under ACOs, decision making is more centralized and controlled. Understanding the influence and linkages of ACOs will help industry stakeholders better visualize and address the quickly changing landscape of coordinated care.