Commonwealth Survey Shows ACOs In Infancy

A nation-wide survey of nearly 1,700 hospitals examining their readiness to form accountable care organizations (ACOs) found that 13 percent are participating in, or planning to participate in, ACOs in the next year, according to a new report from The Commonwealth Fund.

Nearly all (93%) of the ACOs in which hospitals are participating are physician-driven—either created as joint ventures between hospitals and physicians (57%) or physician-led (26%).

The report, Hospitals on the Path to Affordable Care: Highlights from a 2011 National Survey of Hospital Readiness to Participate in an Accountable Care Organization, by researchers at The Commonwealth Fund and Health Research and Educational Trust, also finds that hospitals already involved with ACOs are making progress in improving coordination of patient care and ensuring safe transitions among care settings. Most of these hospitals, about three-quarters (73%), report sharing clinical data among health care settings, including with primary care practices, and 70 percent have processes in place to identify patients moving between care settings such as nursing homes and rehabilitation facilities, who might need additional attention.

Hospitals participating in or planning to participate in ACOs are already emphasizing care for patients with complex needs who are at high risk for being readmitted to the hospital, according to the report. More than half (53%) reported calling patients within 72 hours of their discharge from the hospital to another care setting, and nearly 35 percent said they arrange home visits by advanced practice nurses or physicians for homebound or otherwise complex patients.

Additional Survey Findings:

• Fifty-six percent of hospitals participating or planning to participate in an ACO said they had or were pursuing an ACO contract with a commercial payer or self-insured employer. Thirty-two percent were planning to apply for the Center for Medicare and Medicaid Innovation ACO program.
• While 73 percent of ACO-participating hospitals say they share information across care settings, only 35 percent have the ability to track whether the information exchange has been successful.
• Nearly 85 percent of ACO-participating hospitals have information systems to track how patients use health care services, but there is room for improvement in their readiness to manage sicker patients. Only 19 percent reported using predictive tools to identify high-risk, high-cost patients and only 28 percent have plans to use case managers to support the sickest, most costly patients the ACO will treat.
• When looking at financial risk, the survey found that only 50 percent of hospitals participating or planning to participate in an ACO reported that they have the financial strength to accept risk. Fifty-nine percent have stop-loss or reinsurance provisions, and 69 percent have processes in place for monitoring the use and costs of services compared with revenue received or allowed.

ACOs are intended to promote an enhanced focus on primary care with responsibility for a defined patient population and accountable for achieving benchmark levels of quality and cost.