A Global Review of Accountable Care Organizations: Design Features and Lessons Learned

Abstract

As health systems around the world increasingly adopt accountable care models, certain design features tied to success begin to emerge. This review draws upon lessons learned from three accountable care models: Health Maintenance Organizations, Accountable Care Organizations (ACOs), and Advanced Primary Care.

Five elements are integral to the success of accountable care models. First, continuous strengthening of organizational alignment among health providers within ACOs to achieve shared visions and goals at operational, cultural, and cognitive levels. Second, partnerships to improve the scope of clinical operations (horizontal integration of service lines) to build efficient resource interdependence and collaboration to deliver consistent high-quality care at a scale that includes a full spectrum of clinical services (primary care through long-term care). Third, availability of adequate health information management and health information technology to improve patient management, coordination, and engagement. Fourth, employing risk adjustment models that accurately estimate the cost of the highest-risk patients to ensure sustainable health financing. Finally, using performance benchmarks to incentivize high-performing groups, achieving organizational transformation.

Applying these models’ successes internationally requires leadership to understand cultural and clinical contexts, providers to commit to developing competencies, and governing bodies to address systemic impediments to providers’ ability to work together to improve patient access, experience, and outcomes, while reducing costs.