Paul Keckley looks at the future of Accountable Care Organizations in H&HN. Among his observations

• “Care coordination across multiple sites of care vis á vis an ACO results in improved efficiency and outcomes.”
• “The infrastructure, skill sets, care coordination processes and actuarial risk associated with ACOs is expensive and evolving. Organizations with large, multispecialty medical groups or networks that sponsor their own health plans or have experience in capitated contracts {have} fared best.”
• “The expected increase in health spending to 6 percent annually for the next decade will prompt close attention to the effectiveness of ACOs as a vehicle for reducing cost. Physician-led organizations that adhere to care standardization and incentives for their clinicians linked to cost savings will be sustainable. Others will falter. And industry consolidation means ACO consolidation.”
• ”The centerpiece for sustainable ACOs will be a comprehensive primary care network that integrates physical and behavioral health, pharmacy, dental, eye and nutrition services with heath coaches to change patient behavior. … From these primary care centric models, virtual ACOs that incorporate rural health and teleconnectivity, and clinical models that include social determinants of health in assessing risks and care coordination tactics will evolve.”
• ”The MSSP likely will morph. Quality measures will change. The Shared Savings Program formula will be altered. Some MSSP ACOs will test shared savings with enrollees themselves, rewarding medication adherence or self-care management. CMS will simplify its reporting requirements to encourage continuity in the programs and seek to reduce attrition of participants. And attention to formulary design and medication management, post-acute care coordination, digital connectivity and self-monitoring and alternative health modes of care will become imperatives to achieving savings.”
• ”Medicaid ACOs will be a growth opportunity. The shift of control from CMS to states via block grants or capitated payments will present an opportunity for ACOs, provided their primary and behavioral health capacity is adequate and actuarial risk assessment is precise going in.”

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