The Issue

The accountable care organization (ACO) is gaining ground as a model for delivering better-coordinated health care, lower treatment costs, and improved population health. In their Commonwealth Fund–supported study, Dartmouth researchers analyzed early tracking data to identify the factors affecting ACOs' development and success and then proposed a model for structuring an evaluation framework for these new health care organizations.

What the Study Found

The authors’ analysis revealed the central importance of the following:

  • distinguishing success in implementing an ACO—that is, signing a contract—from operating a successful ACO, 
  • tracking progress over time, and 
  • evaluating the effect of ACOs on three groups: patients under the ACO contract, patients cared for by the organization but not covered by the contract, and the community as a whole.

The ACO evaluation model proposed by the research team includes measures in three categories: contract characteristics; structure, capabilities, and activities; and local context.


Ultimately, the authors say, ACO evaluation should involve a "balanced scorecard" of comparative performance measures. This would enable the Medicare program and other public and private payers to assess what changes in payment arrangements or incentives would promote cost-effective, coordinated care.