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What accountable care organizations will mean for physicians

BMJ 2012; 345 doi: (Published 01 October 2012) Cite this as: BMJ 2012;345:e6461
  1. Rachael Addicott, Harkness fellow
  1. 1School of Public Health, University of California, Berkeley, CA, USA
  1. rachael.addicott{at}

Accountable care organizations are viewed as an important plank in America’s attempts to control its healthcare spending. However, there has been little discussion about the practical implications for physicians. Rachael Addicott spoke to four commercial ACOs about the performance standards physicians must achieve and the consequences of not meeting them

The development of accountable care organizations (ACOs) in the United States has created a climate where the financial success of an entire provider network depends on each physician pulling his or her weight, creating considerable pressure to perform. The use of ACOs in Medicare is still at an early stage, with the launch of 88 new ACOs in July bringing the total number to 153.1 However, the developments and challenges experienced by the 221 organizations already operating as ACOs in the commercial health sector can provide insights into how they affect physicians.2

The fundamental ethos of an ACO is that the contracted providers are eligible to share in a proportion of any savings made in the cost of provision, on the condition that certain quality standards are met. To achieve the intended cost savings, ACO providers typically work together to develop a care management approach targeted at patients at risk of potentially avoidable admissions or emergency department visits. Such care management is either preventive (proactively contacting patients with a high risk profile and deriving a community based care plan) or reactive (care coordinators based in a hospital intercept patients and direct them to other resources).

Quality measures

To avoid one of the primary criticisms of managed care plans in the 1990s—that cost savings will be at the expense of quality and access—ACOs have to meet certain quality measures before any savings are released to them. For the Medicare ACOs, a single set of 33 quality measures has been derived ( …

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