Study find first empirical evidence of external market forces at play
Accountable care organizations are rapidly being formed with the implementation of the Affordable Care Act, and they are being established in areas where it may be easier to meet quality and cost targets, researchers at The Dartmouth Institute for Health Policy & Clinical Practice said in a study published in the journal Health Services Research.
An accountable care organization is a group of providers collectively held responsible for the overall cost and quality of care for a defined patient. ACOs and other value-based payment reforms are intended to address long-standing problems confronting U.S. health care: uneven quality, unsustainable costs, and care that is fragmented.
Dartmouth researchers looked at the scope of ACO implementation because little is know about what is driving the locations where they are being established. They found that more than half the U.S. population lives in areas where ACOs have been formed, although not all are being treated by physicians that are part of an ACO.
The study confirms concerns that the current ACO model may face barriers to implementation in many regions because formation appears to be driven by demographics and market forces.
The study identified 227 ACOs located in 27 percent of local areas, where the majority of the U.S. population lives. These areas have certain characteristics, such as higher performance on quality, higher Medicare per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location.
"This is the first study to look at the formation of accountable care organizations in a systematic way and to report where ACOs might be more or less likely to form based on the characteristics of the health system and population of patients," said Valerie Lewis, principal investigator. "It is important to know if health care reforms are reaching the U.S. patient population evenly or if their formation may increase disparities in health and health care."