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Building the Path to Accountable Care



The Issue

The development of accountable care organizations (ACOs), which bring together hospitals, physicians, and other health care providers to deliver coordinated, efficient patient care, is still at an early stage. Thus far, there is only preliminary information available about the actual performance of ACOs and no strong evidence about which features of the model are most likely to lead to the goals of better patient outcomes and lower overall costs. 


What the Study Found  

Based on the early experiences of recently formed ACOs, the authors identify five key challenges—and some possible approaches for overcoming them.

  • Generating timely and useful data. The provision of claims data, sophisticated clinical measures, and other data in a timely fashion is essential for ACO clinicians to improve and coordinate care.
  • Overcoming transition costs. The Centers for Medicare and Medicaid Services has taken steps to address transitional development costs, including sharing first-dollar savings with ACOs that meet minimum savings thresholds and establishing a program to finance start-up costs for groups with limited resources.
  • Gaining consumer support. ACOs can allay concerns about provider restrictions by ensuring patient choice. Allowing patients to share in savings achieved by their ACO can also lead to greater support for these organizations.
  • Learning what works. It will be important to track and evaluate public and private ACO initiatives so policymakers can make midcourse corrections and ACOs and payers can be better informed about successful strategies.
  • Clarifying the path forward. The inevitable transition from fee-for-service reimbursement will require providers to determine ways to improve care and lower costs using emerging payment methods.



The success of the ACO model is not assured, but early results are promising. An accelerated transition toward accountable care offers a better and more hopeful path for both the public and providers.

Publication Details



E. S. Fisher, M. B. McClellan, and D. G. Safran, "Building the Path to Accountable Care," New England Journal of Medicine, Dec. 29, 2011 365(26):2445–47.