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Accountable Care Organizations in the United States: Market and Demographic Factors Associated with Formation
Author(s) -
Lewis Valerie A.,
Colla Carrie H.,
Carluzzo Kathleen L.,
Kler Sarah E.,
Fisher Elliott S.
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12102
Subject(s) - business , medicaid , medline , health care , economic growth , political science , economics , law
Background The Accountable Care Organization ( ACO ) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation. Objective To determine the number of accountable care organizations in the United States, where they are located, and characteristics associated with ACO formation. Study Design, Methods, and Data Cross‐sectional study of all ACO s in the U nited S tates as of A ugust 2012. We identified ACO s from multiple sources; documented service locations (practices, clinics, hospitals); and linked service locations to local areas, defined as D artmouth Atlas hospital service areas. We used multivariate analysis to assess what characteristics were associated with local ACO presence. We examined demographic characteristics (2010 A merican Community Survey) and health care system characteristics (2010 Medicare fee‐for‐service claims data). Principal Findings We identified 227 ACO s located in 27 percent of local areas. Fifty‐five percent of the US population resides in these areas. HSA ‐level characteristics associated with ACO presence include higher performance on quality, higher Medicare per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location. Conclusions Much of the US population resides in areas where ACO s have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context.