The footprint of accountable care organizations (ACO) continues to expand. As of the end of the first quarter of 2017, there are 923 ACOs covering 32 million lives in the country, marking an increase of 92 ACOs and 2.2 million covered lives in one year’s time (see Growth Of ACOs And Alternative Payment Models In 2017). These ACOs have 1,366 contracts – 715 commercial, 563 Medicare, and 88 Medicaid. Their coverage now extends to 10% of the U.S. population – with a low of two percent in Wyoming and West Virginia, and a high of 30% in Rhode Island and Maine.
These overall numbers mask a lot of churn in the ACO market. Health Affairs reports that at the end of 2016, 55 ACOs dropped out of the Medicare market (see Accountable Care Organizations In 2016: Private And Public-Sector Growth And Dispersion). At the same time, we are seeing new opportunities for ACOs within Medicaid – Massachusetts Medicaid Picks 18 Provider Organizations For MassHealth ACO Program and Minnesota Adds New Risk Sharing For Medicaid ACOs In Expanded Integrated Health Partnerships Program. And we have reported on a number of new ACO initiatives such as National Accountable Care Organization Launched By United Health Group, University Of California, San Francisco, John Muir Add 7 Hospitals, 3 Medical Groups To Accountable Care Organization, and Mostashari’s Startup Creates Aledade ACO In Pennsylvania.
The question for executives of specialty provider organizations is where do ACOs fit in your strategy? ACO executives view behavioral health and social services as important. A study funded by the Robert Wood Johnson (RWJ), Performance Evaluation: What Is Working In Accountable Care Organizations?, found that behavioral health and social services topped the list of concerns for ACO executives. A survey found that the majority of ACO executives see inadequate funding for behavioral health (89%) and social services (79%) as the two largest barriers communities face addressing social needs – and 100% of survey respondents agreed that more behavioral health programs were needed to improve overall community health. ACO executives also reported that their greatest needs in terms of staffing and programming within their ACO were related to behavioral health care (see ACO & Consumers With Complex Needs).
But, will ACOs contract with existing specialty provider organizations or build their own capacity? If you’re with a provider organization that wants a significant role in the delivery of those specialty services, your team needs a strategy that is built on an understanding of how ACOs are approaching care management and partnerships (see How To Build Successful ACO Health Plan Partnerships). And further complicating the strategy picture – every market and every ACO is slightly different.
To build your strategy, you may want to start with these two OPEN MINDS Market Intelligence Reports – The 2016 OPEN MINDS Medicaid ACO Trend Update and The 2016 OPEN MINDS Medicare ACO Update: A Three-Year Trends Report. And, check out these resources from the OPEN MINDS Industry Library:
- Building The ‘Next Generation’ Behavioral & Social Service ACO
- New ACO Developments, Same Challenges
- Who Are The ‘Big Winners’ Of Medicare ACO Bonus Payments?
- More Than 560 Medicare ACOs Will Participate In 2017
- 45 ACOs Selected For Next Generation ACO Model
- 62% Of ACOs Launched In 2012 Implemented Behavioral Health Initiatives
- 61% Of ACO Contracts Only Include Upside Financial Risk
- Most ACOs Not Ready For Two-Sided Risk Model
For a deep dive into the overlap between ACOs and medical homes, join Shauna Reitmeiter, Chief Executive Officer at Northwestern Mental Health Center and OPEN MINDS Senior Associate Steve Ramsland, Ed.D. on August 17 at The 2017 OPEN MINDS Management Best Practices Institute for their session, “Best Practices In Care Coordination: Health Homes, Medical Homes, & More.”