Hospital systems more likely to act as ACO champions

A Leavitt Partners study has identified 164 entities that thus far have identified themselves as Accountable Care Organizations (ACOs) or have adopted the basic tenets-such as financial accountability for the healthcare needs of a population, managing the care of that population and bearing that responsibility at an organizational level. It's too early to tell how many of these entities are following the Medicare Shared Savings Program or have created unique arrangements instead.

To date, there is no consensus regarding which models are best. In fact, the study's authors, who created the list by sourcing news releases, media reports, trade groups, collaborations and interviews through September, acknowledge the limitations of its data. A group could define itself as an ACO even without any active accountable-care contracts.

Surprisingly, hospital systems sponsor the overwhelming majority of ACOs identified by the study. Of the 164 ACOs, 99 are sponsored by hospital systems, with 38 by physician groups and 27 by insurers.

Croshaw says he was surprised that hospitals appear the most eager to set up ACOs even though they would seem to be the most reliant on traditional, fee-for-service systems. He attributes that trend to hospitals' fear of being marginalized as competitors acquire physician practices and partner with other providers.

"Large, fixed-cost businesses do not have the ability to adapt quickly to a changing payment system," Croshaw says. "There's a substantial risk of being isolated and marginalized as these teams form. As one team forms in a given hospital referral region, it seems to be spawning additional teams that don't want to be left out of the game."

That integration of care offers additional negotiating leverage, even if the ACO movement stumbles, he says.

All of the ACOs are in 41 states, but only 144 of 306 hospital referral regions have an ACO, suggesting that competing health systems are creating ACOs, according to the report.

Many organizations identifying themselves as ACOs have made only modest changes to the care process, rather than radically redesigning their structure.

"It appears for now, that defining oneself as an ACO represents an acceptance of the direction the industry has been headed rather than an adoption of a truly new form of care delivery," the report concludes.