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Journal Article


Interpretations of Integration in Early Accountable Care Organizations



The Issue

Both public and private payers are supporting the development of accountable care organizations (ACOs) to promote care coordination across health care provider groups and thereby improve quality while controlling costs. In this qualitative study, supported by The Commonwealth Fund, researchers interviewed 114 physicians and managers in four nascent ACOs, conducted site visits, and reviewed documents to explore how those forming ACOs envision integration with other provider groups.

What the Study Found

None of the four groups viewed the ACO as a new overarching entity that would unite disparate groups. Instead, each developed its own interpretation of what integration would mean, as follows:

  • An independent practice association preserved members' sense of autonomy by emphasizing coordination, not integration.
  • A medical group promoted integration among its employed staff, but not with affiliates.
  • A hospital sought to engage community physicians by presenting integration as an equal partnership.
  • An integrated delivery system presented the ACO as a cultural, rather than structural, change.


The ACO model appears to be "flexible enough to work in synchrony with whatever social strategies are most context appropriate," the authors conclude. The achievement of functional integration of provide groups, they say, does not require "identification with a superordinate group."

Publication Details



S. A. Kreindler, B. K. Larson, F. M. Wu et al., "Interpretations of Integration in Early Accountable Care Organizations," Milbank Quarterly, Sept. 2012 90(3):457–83.