Carrie H. Colla, Valerie Lewis, Emily Tierney, and David B. Muhlestein
C. H. Colla, V. Lewis, E. Tierney et al., “Hospitals Participating in Accountable Care Organizations Tend to Be Large and Urban, Allowing Access to Capital and Data,” Health Affairs, March 2016 35(3):431–39.
A new study comparing accountable care organizations (ACOs) that include hospitals in their networks to those that do not finds hospitals that are in urban areas, are nonprofit, or have a relatively small share of Medicare patients are more likely to participate in ACOs than other hospitals. Whether an ACO includes hospitals does not appear to affect its capacity to manage hospital-related aspects of patient care.
In an attempt to curtail needless spending and improve care coordination, many hospitals have teamed up with accountable care organizations (ACOs) over the past decade. Although more than half of ACO provider networks now include hospitals, the jury is out on the value ACOs derive from hospital participation. Commonwealth Fund–supported researchers used quantitative and qualitative analysis to assess the differences between ACOs with and without participating hospitals.
"Of the goals inherent in the creation of ACOs, the ability to control spending may provide the strongest business case for including hospitals in ACOs."
Leaders of ACOs that include hospitals in their networks say that hospitals provide an important source of capital for funding the infrastructure work needed to support quality reporting, among other projects. Additional strategic advantages of hospital participation include having the capacity for data-sharing between inpatient and outpatient settings and the ability to engage providers across care settings. Other ACO leaders feel, however, that hospitals cannot fully commit to cutting spending, as doing so entails reductions in revenue from inpatient and emergency department services. With no participating hospitals, organizations can better commit to accountable care because they “[do] not have to worry about decreasing hospital revenue.”
Researchers analyzed data from 269 ACOs that responded to the National Survey of Accountable Care Organizations from October 2012 to March 2014 and information from Leavitt Partners’ ACO database. They also conducted interviews and site visits to examine ACO characteristics, identify the types of hospitals that participate in ACOs, and investigate differences that participation makes in ACOs’ ability to control costs.
Although accountable care organizations that involve hospitals in their operations offer more-comprehensive services than those that do not, hospital inclusion does not appear to affect ACOs’ capacity to manage hospital-related aspects of patient care.