Accountable Care Organizations: Will They Deliver?

The health reform debate has focused on rewarding providers more for delivering quality care to their patients than for increasing the volume of services they provide (Gold and Felt-Lisk 2008). Accountable care organizations (ACOs) are one proposed way of changing payment sys-tems to achieve this goal by creating incentives to increase clinical integration and care coordi-nation (Rittenhouse et al. 2009; Fisher et al. 2006). This brief examines the ACO concept broadly.1 We define the concept and rationale for inter-est in it, review what has been learned from previous initiatives, and place ACOs in the context of the broader health care system. From this context, we draw insights for policymakers in the public and private sectors. (Note that the design and implementation of ACOs in connection with Medicare and health reform have been discussed elsewhere, for example, MedPAC 2009; Devers and Berenson 2009; Crosson et al. 2009.) Issues at a Glance Accountable care organizations (ACOs) seek to reshape the way care is delivered and the way providers with shared responsibility for patients are rewarded. The intent is to encourage providers to consider all of the care their patients receive and to coordinat