SALT LAKE CITY, UT – A recent white paper from the Leavitt Partners’ Center for ACO Intelligence gave some interesting insight into the types, growth and location of ACOs. The report is the first of its kind, using data and analysis on the growth and national dispersion trends of more than 160 ACOs.
Here are five things to note about the growth of ACOs:
1. Dispersion of ACOs varies by market. According to the report, there is “extreme variation in the present growth of accountable care organizations, with some markets having multiple ACOs and others having none.” ACO growth, the study says, tends to be a reaction to other organizations in the market. For instance, when one institution forms an ACO, its competitors often follow. “Healthcare delivery in America is still primarily a cottage industry with few national healthcare providers,” the report read. “Most health service providers are regional and are focused around one market area, whether because of simplicity of dealing with one state law, the difficulties in expanding beyond a relatively small footprint, or other reasons.” The report mapped 140 ACOs, and of those, 127 didn’t extend beyond one state. “Generally, states with larger populations are associated with more ACOs, though the trend in the South, through the plans states and into the mountain west, is toward fewer ACOs,” the report read.
[See also: ACOs offer new risks and rewards.]
2. Specific regions of the U.S. are lacking in ACOs. Although ACO growth is extensive in some regions, believe it or not, others have no current ACO activity. These regions include poorer and more rural regions in particular. A map included in the study showed a dearth of ACOs in the Southeast and Appalachian regions, “which consistently rank as the least healthy areas of the country, with a high prevalence of obesity, heart disease, diabetes and other chronic diseases,” the report read. “Accordingly, it would seem that these regions stand to benefit the most from coordinated care. The reason for the lack of ACOs in these regions is unclear.”
3. Hospitals and hospital systems are the main backers of ACOs. Almost two-thirds of ACOs identified were started by hospitals or hospital systems, the report documented. “Insurers and Physician Groups, though, are also adopting tenets of accountable care and are backing ACOs throughout the country.” According to the report, in evaluating the sponsoring entity, each was defined as a hospital or health system, an independent physician association (IPA) or as an insurer. “In actuality, some ACOs were started by organizations that do not clearly fit into one of these three categories, and others were formed as joint ventures,” read the report.
[See also: ACOs key to healthcare overhaul, Berwick says.]
4. Investments in the ACO model exist independently of the Medicare Shared Savings Program. “Though the Medicare Shared Savings Program final regulations have been released, implementation is still in its infancy,” read the report. “Regardless, ACO growth is happening independent of Medicare, as multiple entities throughout the country are already operating under an accountable care payment contract.” With the program still to be implemented, the substantial growth of ACOs indicates a trend within the industry toward the ACO model, particularly independent of government incentives. “Under the Shared Savings Program, entities must be care providers to qualify, but non-provider insurance companies are a major backer of ACO growth, indicating a much broader definition of what type of entity can provide accountable care,” said the report. “Important insights will be drawn by observing which models succeed in reaching the overriding goal of increasing value through improving quality, lowering costs or both.”
5. The success of different ACO models is still unproven. According to the report, although there are different models of providing accountable care, which approaches are most successful at realizing an ACO’s goals is still unclear. “With neither a set definition, nor a national method for identifying ACOs, it is difficult to precisely identify and study such organizations,” the report read. “It is possible that some of the organizations, which should be considered ACOs, are missing from our study and some, such as organizations that self-identify as ACOs but will never ultimately adopt any type of care coordination or bear any risk for a population, may not belong.” Limitations with mapping also prohibit clear findings, while some ACOs are organized by regional or national entities that may cover ill-defined patient populations in many states. In turn, this makes “completely accurate determination of the geographical region that the ACO covers unknowable.”
Follow Michelle McNickle on Twitter, @Michelle_writes
