New Commonwealth Fund white paper caucuses on strategies for implementing ACOs


The Commonwealth Fund released a new white paper on lessons learned from members of the Premier healthcare alliance’s accountable care collaborative.

The white paper provides an overview of accountable care organizations (ACOs) and strategies for their implementation based on the perspectives from health system members of Premier’s Partnership for Care Transformation (PACT™) collaborative. PACT members are breaking down payment silos and creating integrated provider networks that are accountable for cost, quality, satisfaction and population health.

While much attention has been paid to the public policy around ACOs, there has been less focus on the organizations that are building, testing and bringing to scale new models of care delivery. The white paper details the following steps to developing an ACO model that can be replicated by hospitals, health systems and physician practices:

  • Many different organizational models could work for ACOs. It is not necessary for an ACO to be a single, co-owned entity, or for providers to “own” their ACO networks.
  • ACOs must align business with value-based payments. Working under shared savings and fee for service creates parallel business models. It is essential to align payments quickly to move toward value-based care.
  • Leaders need to design collaboration incentives. Physicians should receive incentives to deliver high-quality care based on pre-defined measures, but they must be able to influence the approach.
  • ACOs need financial modeling to assess economic impact. This helps set appropriate targets for short- and long-term budgets and supports evaluations of payment options, including the two Medicare Shared Savings Program tracks, capitated payments and private payor arrangements.
  • Extensive investment in HIT is needed to coordinate care. Providers need seamless coordination with sophisticated population health status measurement to improve health and reduce costs.
  • ACOs must measure performance on a broad range of measures. ACOs require aggregated data on utilization, demographics, financial performance, quality scores and other metrics at least quarterly. This information must be linked across the continuum to support predictive modeling, targeted services, provider evaluations and patient interventions. Reports need to be relevant, presenting information in a digestible, actionable format.

“By emphasizing wellness and prevention, and facilitating clinical integration across all providers with people at the center, ACOs will improve population health,” said Susan DeVore, Premier president and CEO. “But it won’t be simple. Deployment requires operational and technological capabilities, combined with good partnerships that span the care continuum. Success in these new delivery models will offer a dramatic shift in the financing and delivery of healthcare, a change that will touch virtually everyone providing, receiving or funding it.”

Premier, a provider-owned alliance of more than 2,600 U.S. hospitals and 86,000-plus other sites, operates the nation’s largest performance improvement care network.

The alliance created PACT to identify and address the gaps and inequities in the quality of care delivered nationwide. Since its inception in 2010, PACT’s Implementation collaborative of 23 heath systems, including 70 hospitals, have shared best practices while measuring and benchmarking their care to improve health, healthcare and cost containment. These providers deliver care across 20 states and cover urban, rural and suburban populations. Members of PACT’s Readiness collaborative include 46 systems in 58 markets representing 201 hospitals covering 30 states.

About The Commonwealth Fund

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.

About the Premier healthcare alliance, Malcolm Baldrige National Quality Award recipient

Premier is a performance improvement alliance of more than 2,600 U.S. hospitals and 86,000-plus other sites using the power of collaboration and technology to lead the transformation to coordinated, high-quality, cost-effective care. Owned by hospitals, health systems and other providers, Premier operates a leading healthcare purchasing network with more than $4 billion in annual savings. Premier also maintains the nation's largest clinical, financial and outcomes database with information on 1 in 4 patient discharges. A world leader in delivering measurable improvements in care, Premier works with the Centers for Medicare & Medicaid Services. Headquartered in Charlotte, N.C., Premier also has an office in Washington. https://www.premierinc.com.