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Journal Article


An Early Assessment of Accountable Care Organizations’ Efforts to Engage Patients and Their Families

healthcare hospital patient doctor

The Issue

Accountable care organizations (ACOs) are expected to play a significant role in meeting cost and quality targets outlined in the Affordable Care Act. To do so, ACOs will need to actively engage patients in their own health care. But adoption of patient activation and engagement (PAE) activities among ACOs is low. A Commonwealth Fund-supported study assessed PAE activities in ACOs and identified some of the obstacles organizations face in implementing them.

What the Study Found

Across all ACOs surveyed, support for PAE activities was high. The majority reported implementing strategies like sending patients follow-up and reminder notices and allowing patients access to their medical records. In addition, about 45 percent of ACOs reported that high-risk, chronically ill patients received some form of health coaching.

Contrary to expectations, the study found no correlation between the likelihood of pursuing patient engagement efforts and ACO size, ownership, or physician compensation practices. Researchers did note a strong correlation between leadership support for PAE and greater use of engagement strategies. While only one-quarter of ACOs had calculated a return on investment for PAE efforts, those that did reported a return of between two-to-one and four-to-one, mostly because of lower emergency room use and hospital admissions.

Some of the major barriers to adoption reported by ACOs include: competing priorities, the need to redesign work flows and develop new communication skills, educating providers, and committing the necessary time and resources.


While the study found strong support among ACOs for PAE activities, early efforts in this area face many significant challenges. The authors note that further progress on engaging patients will likely depend on continued support among ACO senior leadership, advances in health information technology, and expanded use of health coaches.

Read the article.

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


S. M. Shortell, N. J. Sehgal, S. Bibi et al., “An Early Assessment of Accountable Care Organizations’ Efforts to Engage Patients and Their Families,” Medical Care Research and Review, published online June 2, 2015.