Accountable Care Organizations: Development, Taxonomy, Quality and Cost Effect

Principal Investigator: Askar S. Chukmaitov, M.D., Ph.D.

Funding Source: Agency for Healthcare Research and Quality Grant No. 1R01HS023332-01


The Affordable Care Act (ACA) of 2010 goals are to improve the quality of care and contain health care costs while eventually expanding health coverage to millions of uninsured Americans.  The ACA includes provisions to begin addressing these goals, partly through the development of Accountable Care Organizations (ACOs).

Rapid development of public ACOs with active hospital participation is underway. The CMS initiated the Medicare Shared Saving Program (MSSP) and the Pioneer ACO Program.  To provide policy guidance, we make innovative use of currently available data for 2009-2014 to examine whether new ACO structures and competencies that health care policy makers, researchers, and practitioners have identified as critical for achieving ACA goals fulfill the promise of improving health care quality and containing health care costs.

Study Design

The effects of changes in a range of hospital-related ACO structures developed via taxonomic analysis will be evaluated by examining changes in hospital quality of care and costs for Medicare patients treated by hospitals participating in the CMS ACO programs, before and after their designation, and in comparison with the Medicare patients treated in hospitals that are not participating in the CMS ACOs.  The taxonomy of hospitals participating in the CMS ACOs will enable tracking ACO progress and success.  Social, market, and geographic factors, and hospital organizational drivers conducive to ACO development will be evaluated using the nationwide data. 

Intended Policy Outcomes

This study focuses on hospitals as their participation in CMS ACOs offers utmost potential for cost containment and quality improvement by incentivizing value rather than volume and coordinating care across providers. Hospital performance will be measured by comprehensive sets of quality and cost outcomes that assess effectiveness of care coordination on the continuum of care across providers and hospital cost containment for all Medicare patients.