Medicare's accountable care organizations were designed to deliver more cost-effective care, but physicians participating in those ACOs are only moderately convinced that they do so, according to a new survey from Health Affairs.
The findings come at a time when ACOs are on the rise. As of January, the number of Medicare ACOs had grown to 562, and since the program began in 2012, it has served about 10.5 million patients. Yet a key prerequisite for their success is primary care physicians' willingness to involve themselves in the process of change, and only about half of the physicians surveyed think it's an effective model for delivering cost-effective or high-quality care.
Of the 1,401 physicians surveyed, 405 participate in the Medicare Shared Savings Program model, 549 in the Advance Payment Model, and 447 in the Pioneer model. More than two-thirds of these physicians agreed that their personal practice style was compatible with payments linked to quality instead of fee-for-service. Health Affairs said it's possible they believe they don't need an ACO's structure or strategies to adapt to new care delivery methods.
Across all three ACO models, knowledge gaps remain, as one-half to one-third of physicians said they were unsure whether they were eligible to receive shared savings. Similar numbers reported they didn't know whether they or their practice were at risk for financial losses, while one-fifth to one-half didn't know for which of their patients the ACO was responsible.
Direct involvement by the physician in the decision to take part in the program varied by ACO model. About 65 percent of physicians in Advance Payment ACOs were a part of the decision, compared with 30 percent of those in Shared Savings Program ACOs and just 19 percent of those in Pioneer ACOs.
According to Health Affairs, the results suggest that many physicians' views are now aligned with ACO goals, and they're divided as to whether the model is effective. But those same physicians seem largely comfortable with their own ability to adapt to the shift toward value-based payment, so they may not see the ACO model as necessary to their success in that regard.
The results indicate that ACOs need to increase their efforts to determine which of their goals match up with those of the participating physicians. Some physicians might require more consistent performance feedback and education about best practices, while others may benefit from participating in ACO governance. Still others may require more direct financial incentives, perhaps through increased risk sharing.