Accountable Care Organizations

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Accountable Care Organizations (ACOs) have the potential to help move the current system away from the outdated fee-for-service structure to one that incentivizes quality, value and better health outcomes for patients. ACO Map 

Health plans continue to lead and collaborate in efforts with providers, hospitals, and health systems to reform payment and the delivery of care to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care. These initiatives have demonstrated better health outcomes, improved patient safety, fewer preventable hospital readmissions, and lower health care costs.

As ACOs mature, policymakers and regulators will need to monitor potential unintended consequences and adverse effects such as provider consolidation, which may drive up medical prices and result in additional cost-shifting to families and employers with private insurance coverage. 

Through the CMS Innovation Center ACO demonstrations and initiatives, there are opportunities for Medicare and Medicaid to begin building on the successes of the innovative payment systems that exist in the private marketplace today.  If implemented as intended, ACOs could improve the quality and safety of patient care and help put our system on a sustainable path. 

Provider Consolidation Infographic 

(click thumbnails to view larger images)

Latest Resources

New Analysis in Health Affairs Assesses Performance Measures Across Public Private Sectors

A new study in Health Affairs authored by researchers at America’s Health Insurance Plans (AHIP) offers one of the first systematic assessments of health plans’ use of performance measures in payment and delivery models.

Press Releases | Strategic Communications | 08/06/2013

U.S. Map of Alternative Delivery and Payment Models - Private Sector Initiatives - [PDF]

Map of the U.S. showing private sector alternative delivery and payment activity by state – patient centered medical home, accountable care arrangements, bundled or episode of care, and comprehensive global payment models.

Charts | Clinical Affairs | 02/15/2013

New Analysis in Health Affairs Outlines Framework for Effective Public-Private Sector Collaboration in Payment and Delivery System Reform

As payment and delivery system reform expands across the country, it is critical that public sector initiatives complement and build upon the successful efforts currently underway in the private sector, according to an article in the latest edition of Health Affairs.

Press Releases | Strategic Communications | 09/04/2012

Embracing Accountable Care: 10 key Steps - [PDF]

This Point of View examines key steps payers must take to establish and successfully manage ACOs — enhancing their ability to remain competitive through 2012 and beyond.

Marketplace White Papers and Multimedia | 12/01/2011

Health Plans and Providers Partnering to Advance Accountable Care

New health care delivery and payment models in the private sector are being shaped by active collaboration between health insurance plans and providers, according to a new study by America’s Health Insurance Plans (AHIP) that appears in the September edition of Health Affairs.

News Articles | Strategic Communications | 09/08/2011

AHIP Letter to HHS Recommending Improvements to ACO Regulation - [PDF]

In its letter to HHS, AHIP recommends that the ACO regulation build on private-sector accountable care models, utilize the programs health plans have implemented to transform the delivery system, transition away from the outdated fee-for-service system, and avoid increasing provider consolidation and cost-shifting that would lead to higher costs for consumers.

AHIP Comment Letters | 06/06/2011

AHIP Statement on Medicare Shared Savings Program

America’s Health Insurance Plans’ (AHIP) President and CEO Karen Ignagni released the following statement on the proposed regulations released today by the Department of Health and Human Services on accountable care organizations (ACOs).

Press Releases | Strategic Communications | 03/31/2011

Accountable Care Organizations and Market Power Issues - [PDF]

In an effort to assist policymakers, regulators, providers, health plans, and others in considering the rules and regulations that are being formulated for ACOs, AHIP hosted a forum on ACOs on September 23, 2010, in Washington, DC that included a panel of four experts who provided guidance on the implementation of the Shared Savings Program and discussed various aspects of market power and antitrust concerns as they relate to ACOs.  This paper summarizes the key lessons and themes discussed by the presenters as well as the participants.

Reports/Research/White Papers | 10/20/2010

Expanding the ACO Concept to Encourage Innovation, Accountability and High Performance and the Value Health Plans Bring to Delivery System Transformation - [PDF]

Both the public and private sectors are exploring and implementing innovative care and payment models designed to improve delivery of care and encourage Americans to stay healthy. This white paper examines the concept of Accountable Care Organizations (ACOs), often defined as organizations of health care providers that agree to be held accountable for the quality, cost and overall care for a defined population of patients and that seek to receive shared savings if they meet certain quality and costs goals.

Reports/Research/White Papers | 09/13/2010