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Accountable care organizations in the USA: Types, developments and challenges

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  • Barnes, Andrew J.
  • Unruh, Lynn
  • Chukmaitov, Askar
  • van Ginneken, Ewout

Abstract

A historically fragmented U.S. health care system, where care has been delivered by multiple providers with little or no coordination, has led to increasing issues with access, cost, and quality. The Affordable Care Act included provisions to use Medicare, the U.S. near universal public coverage program for older adults, to broadly implement Accountable Care Organization (ACO) models with a triple aim of improving the experience of care, the health of populations, and reducing per capita costs. Private payers in the U.S. are also embracing ACO models. Various European countries are experimenting with similar reforms, particularly those in which coordinated (or integrated) care from a network of providers is reimbursed with bundled payments and/or shared savings. The challenges for these reforms remain formidable and include: (1) overcoming incentives for ACOs to engage in rationing and denial of care and taking on too much financial risk, (2) collecting meaningful data that capture quality and enable rewarding quality improvement and not just volume reduction, (3) creating incentives for ACOs that do not accept much risk to engage in prevention and health promotion, and (4) creating effective governance and IT structures that are patient-centered and integrate care.

Suggested Citation

  • Barnes, Andrew J. & Unruh, Lynn & Chukmaitov, Askar & van Ginneken, Ewout, 2014. "Accountable care organizations in the USA: Types, developments and challenges," Health Policy, Elsevier, vol. 118(1), pages 1-7.
  • Handle: RePEc:eee:hepoli:v:118:y:2014:i:1:p:1-7
    DOI: 10.1016/j.healthpol.2014.07.019
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    References listed on IDEAS

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    1. Liutang Gong & Hongyi Li & Dihai Wang & Heng-fu Zou, 2010. "Health, Taxes, and Growth," Annals of Economics and Finance, Society for AEF, vol. 11(1), pages 73-94, May.
    2. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
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    1. Field, Robert I. & Keller, Catherine & Louazel, Michel, 2020. "Can governments push providers to collaborate? A comparison of hospital network reforms in France and the United States," Health Policy, Elsevier, vol. 124(10), pages 1100-1107.
    2. Fernanda Bravo & Retsef Levi & Georgia Perakis & Gonzalo Romero, 2023. "Care coordination for healthcare referrals under a shared‐savings program," Production and Operations Management, Production and Operations Management Society, vol. 32(1), pages 189-206, January.
    3. Elodie Adida & Fernanda Bravo, 2019. "Contracts for Healthcare Referral Services: Coordination via Outcome-Based Penalty Contracts," Management Science, INFORMS, vol. 65(3), pages 1322-1341, March.
    4. Moran, Valerie & Allen, Pauline & Sanderson, Marie & McDermott, Imelda & Osipovic, Dorota, 2021. "Challenges of maintaining accountability in networks of health and care organisations: A study of developing Sustainability and Transformation Partnerships in the English National Health Service," Social Science & Medicine, Elsevier, vol. 268(C).
    5. Palazzolo, Jennifer R. & Ozcan, Yasar A., 2018. "Do the most efficient accountable care organizations earn shared savings?," Socio-Economic Planning Sciences, Elsevier, vol. 63(C), pages 12-17.
    6. Vanessa Ress & Eva‐Maria Wild, 2024. "The impact of integrated care on health care utilization and costs in a socially deprived urban area in Germany: A difference‐in‐differences approach within an event‐study framework," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 229-247, February.

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