Challenges of Accountable Care Organizations

As health care evolves from fee-for-service to shared-savings model, accountable care organizations are a key component in driving this evolution. ACOs can be broadly defined as: "a group of health care providers who accept shared accountability for the cost and quality of care delivered to a population of patients." This concept places the financial risk of each patient's care on the group of providers.

There have been many obstacles blocking the success of implementing the ACO model nationwide. At a recent summit, I attended a session about why ACOs have not been successful, and many challenges were discussed, such as:

• Not enough time to implement correctly; expecting results too quickly
• Limited resources for appropriate funding for the right technology
• Getting the right data to effectively manage the care
• Physician engagement so they are more invested in the success of the ACO
• Need more investment to actually make a cultural change
• Need expertise necessary to successfully negotiate value-based contracts with payers
• How does population health “fit” when administrators want to sell off parts of the hospital?
• Referral management and impacting current referral patterns
• Collaboration with hospitals and specialists outside the ACO
• Implementing and maintaining patient and family engagement, which is a critical challenge to overcome as patients are key to successfully managing their care and bringing costs down

So what is next? How do we move forward? Why ACOs have not been successful is currently the topic of many healthcare articles because the conversation now turns to the next phase of accountable care organizations. Phase two implementation focuses on more complex things like bundled payments and care coordination, thus increasing the complexity of operating a successful organization. This focus makes it necessary to perfect the initial implementation of ACOs.  

Physician engagement, patient engagement, and better data are crucial to success. Each one is a big initiative.  ACOs, even with the challenges they present, are still considered a workable model for the future. Are we expecting too much too soon?