Pitfalls in ACO design

Physician partners, data systems, and assignment of risk all play an important part in the care and feeding of ACOs

Care coordination networks are a mainstay of the Affordable Care Act’s cost reduction goals. Accountable care organizations, or ACOs, are the most widely recognized of these networks, yet by no means is design of these business arrangements simple or straightforward.

In a basic sense, an ACO joins physicians and hospitals to collectively share financial and medical responsibility for a defined group of patients over a certain period of time. But the universe of possible structures is quite large.

“One of the first things a hospital has to decide is what entity is going to take on the financial risks,” said Henry Chung, MD, chief medical officer of Montefiore Medical Center’s Care Management Organization in the Bronx, N.Y. “Sometimes the hospital may want to take the risk themselves. In other scenarios, hospital and community doctors come together to form a new company.”

In the world of ACOs, another important piece of the puzzle is organizing a group of participating physicians. There needs to be a robust, outpatient primary care-oriented system. Savings are largely going to come from keeping people out of the hospital and by reducing unneeded testing and procedures.

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