Analyzing Accountable Care Organizations


In 2010, the Affordable Care Act was signed into law with the goal of improving healthcare quality, containing costs and expanding coverage to 33 million uninsured Americans.

One way the law addresses those goals is through Accountable Care Organizations. ACOs are legal entities made up of providers who work together to manage and coordinate care for Medicare patients. Their goal is to contain costs and improve measurable health outcomes, such as decreasing the number of hospital readmissions.

ACOs are rewarded to improve healthcare quality by setting provider payment on patient outcomes. For example, if a patient is discharged from a hospital but returns within 30 days for the same condition, the hospital won’t receive a bonus payment. That motivates ACO participants to make sure they effectively coordinate care among pharmacists, primary care physicians, family caregivers and other practitioners to ensure excellent follow-up care.

To study the efficacy of such organizations, Askar Chukmaitov, M.D., Ph.D., of the Virginia Commonwealth University Department of Health Behavior and Policy is leading a three-year, grant-funded study, “Accountable Care Organizations: Development, Taxonomy, Quality and Cost Effect.”

The study will, in part, examine the nation’s two major ACO programs: the Medicare Shared Saving Program and the Pioneer ACO Program. Both were initiated by the Centers for Medicare and Medicaid Services and, together, have about 600 participating hospitals.

Chukmaitov wants to identify which factors drive hospitals to participate in ACOs, to classify the different types of participating hospitals (hospital-system-led versus physician-led and other ACO competency factors) and to determine if those hospitals are actually containing costs and seeing improved quality of care.

To do that, his team will gather data from 2009-2013 using national databases and resources such as the American Hospital Association’s annual survey of hospitals. Then they’ll analyze the performance of hospitals before and after they joined ACOs. The team will also compare data of ACO hospitals with those that don’t participate in one.

The information will be used to develop a taxonomy of ACO hospitals that displays which characteristics of hospitals tend to improve quality and reduce costs, which will in turn help providers and policy makers as they refine ACO programs across the nation.

“This project is timely because ACOs are rapidly developing across the country,” Chukmaitov says. “Our research will provide a much-needed evidence base for the ongoing national policy debate about what kinds of hospitals hold promise for improving the performance of U.S. healthcare systems.”

* Askar Chukmaitov, M.D., Ph.D., was supported by a research grant, 1R01HS023332-01, from the Agency for Healthcare Research and Quality. For complete details about the study, view our current projects.