AAFP Advocacy Focus: Accountable Care Organizations (ACOs)

Overview

An accountable care organization is a group of health care providers — including primary care physicians, specialists, hospitals and extended-care facilities — that is held accountable for the cost and quality of care delivered to a defined subset of traditional Medicare program beneficiaries or other specific populations, such as commercial health plan subscribers. The medical home is among the model's methods for achieving coordinated care delivery.

The AAFP has been closely involved in the evolution of the ACO model, both with private-sector payers and with CMS, consistently advocating for the inclusion of a number of ACO elements and concepts, including:

• physician leadership, effective clinical integration and true partnerships among all participants;
• voluntary participation by physicians and patients;
• nationally accepted, validated clinical measures focused on ambulatory and inpatient care to monitor performance and augment efficiency and patient experience metrics;
• integrated information systems that provide relevant information at the point of care and assist in coordination among clinicians across multiple transitions of care;
• clearly defined organizational relationships, spending and quality benchmarks, and payment distribution mechanisms;
• incremental implementation of ACO structures and payment systems;
• optional participation in multiple ACOs by primary care physicians and sub-specialists; and
• effective incentives for patient engagement.

The ACO model will become increasingly important in shaping health care delivery in the years ahead. Because primary care is at the core of the ACO approach, the AAFP will closely track developments and continue to articulate the interests and concerns of family physicians.

Why We Fight

Primary care is the foundation of the ACO model. And ACOs represent a framework for family medicine centered on providing accessible and effective health care to patients in an integrated, team-based setting, rewarding quality of care over volume of care.

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