The number of participants in Accountable Care Organizations (ACOs) has jumped significantly within the past three years, according to the June CardioSurve. Of those cardiologists surveyed, nearly one out of five (19%) are currently in an ACO, up from just 1% in 2011. The largest ACOs in which ACC members participate include Partners Healthcare, Valley Preferred Aetna, Cleveland Clinic Cigna and Carolinas Healthcare System. Additionally, more than 1 out of 3 ACO non-participants indicated a high likelihood of participating in an ACO in the future.
ACOs are defined as a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients with the goal of reducing health care costs. The ACO concept, which initially debuted around 2006, gained traction in 2010 with the passage of the Affordable Care Act and the inclusion of a provision directing the Centers for Medicare and Medicaid Services (CMS) to create an ACO "program" by no later than Jan. 1, 2012. Under the CMS program, each ACO has to manage the health care needs of at least 5,000 Medicare beneficiaries for a minimum of three years.
Given the relative newness of the ACO concept, it's not surprising that 76% of respondents already participating in an ACO have only been doing so for two years or less. Hospital-owned practices were more likely to be participating in an ACO, followed by medical school-owned (25%) and physician-owned (19%). The majority of ACOs included a medical group (88%), hospital (84%) and a specialist group (68%). Two out of five ACOs involved an integrated delivery system. Nursing homes (16%), federally qualified health centers (12%) and rural health clinics (4%) were less common.
Also not surprising given the short history of ACOs, more than two out of three survey respondents (68%) said the jury is still out in terms of satisfaction with their ACO. Only 12% were very satisfied with their ACO, while another 20% said they were not satisfied. Respondents were also unclear about the overall impact of ACOs on quality improvement with nearly half (48%) saying they were undecided. Slightly more than one out of four respondents (28%) felt ACOs have a strong impact on quality improvement, while 25% said ACOs have no impact.
Despite the uncertainty, there appears to be a broad level of awareness with ACOs among cardiologists in general. Three out of four respondents indicated some level of familiarity with the ACO concept even if they weren't already participating in a program.
In general the ACC is supportive of ACOs and other collaborative payment models that make it feasible for physicians and hospitals to meet the triple aim of better care, improved outcomes and lower costs. The College will be closely watching the growth in ACO participation and will be looking for opportunities to gauge cost-savings and potential impact on quality improvement over time. The College will also continue to work with CMS and the Centers for Medicare and Medicaid Innovation on other innovative payment efforts that allow providers to improve care.