Two studies recently examined predictors of accountable care organization formation — with somewhat inconsistent findings.
One study, conducted by a group at the Dartmouth Institute for Health Policy and Clinical Practice, found ACOs are more likely to be in markets that have higher quality, higher Medicare per capita spending, fewer primary care physician groups, greater managed care penetration and lower poverty rates.
Another study, by the RAND Corporation found three main factors associated with ACO formation: larger physician practices, a greater fraction of hospital risk sharing and larger integrated hospital systems.
Though the studies resulted in different outcomes, a new Health Affairs blog post argues the findings are more similar than they seem. "Their core conclusions…are similar, and differences in the results are readily explained," the authors wrote.
For instance, both studies found the presence of integration, be it by physician groups, hospitals or both, to be important to ACO formation. Additionally, provider experience taking on risk, through managed care or capitation, also plays a role in ACO formation.
Differences between the studies' results can be explained because they used different methods and sample sizes to reach their conclusions, according to the article.
The studies' findings are useful because they raise some important policy questions, such as how providers without experience taking on risk can get involved in the model, the blog writers pointed out.
"Perhaps the most important conclusion…is to acknowledge the many uncertainties that remain," the authors wrote. "The transition to performance-based payment systems has barely begun — and better information on what is working and what isn't would make successful reform more likely."
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