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Accountability Across the Continuum: The Participation of Postacute Care Providers in Accountable Care Organizations

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Each year, more than 40 percent of Medicare beneficiaries discharged from hospitals receive postacute care services—rehabilitation, skilled nursing, and home health care. Accountable care organizations (ACOs), which coordinate their patients’ treatment across all care settings, could play a key role in ensuring these services are appropriately used. Little is known, however, about the extent to which ACOs now engage postacute care providers in managing outcomes and costs.

What the Study Found

  • According to national survey data, among ACOs with Medicare, Medicaid, and commercial payer contracts, 52 percent formally include at least one postacute care service. ACOs with commercial (64%) and Medicaid (70%) contracts have higher inclusion rates, compared to ACOs with Medicare contracts only (45%).
  • Outpatient rehabilitation and inpatient rehabilitation services are most commonly included within ACOs (41% and 35%, respectively). Skilled nursing facilities and services are included only in a small proportion of ACOs (18%).
  • ACOs that include postacute care are more likely to also include services such as palliative and hospice care, behavioral health, and outpatient pharmacy.
  • Those organizations that have a formal relationship with a postacute care provider are more likely to have other capabilities important for managing the care of older populations, such as end-of-life planning, readmission prevention, and care management.
  • Total spending is significantly lower when postacute care is included within the ACO.


ACOs can either formally include postacute care sites in their network or selectively contract with the most efficient providers. Integrating postacute care is important for reducing variation in quality of care and improving outcomes for high-risk, high-cost patients.

Publication Details



Carrie H. Colla, Assistant Professor, Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School

[email protected]


C. H. Colla, V. A. Lewis, S. L. Bergquist et al., “Accountability Across the Continuum: The Participation of Postacute Care Providers in Accountable Care Organizations,” Health Services Research, published online Jan. 22, 2016.