About half of all ACOs are physician-led and serve fewer than 10,000 beneficiaries. About 20% of ACOs include community health centers, rural health centers, and critical access hospitals that serve low-income and rural communities. Fifteen of the newest 106 ACOs are under the Advanced Payment Model, which provides physician-based or rural providers with greater access to upfront capital to invest in staff, electronic health record systems, or other infrastructure needed to improve care coordination. Medicare recoups advance payments through future shared savings, CMS said.
The shared-savings initiatives began in late 2011 when CMS launched the Pioneer ACO program for large provider groups able to take greater financial risk for the costs and care of their patients over time.
Dignity Health Arizona, a three-hospital system in Phoenix, was very interested in the Pioneer ACO program but found the specifications too lacking in detail, says Chief Integration and Development Officer Mark Hillard. Dignity Health Arizona spent the ensuing 15 months establishing a network of physicians to enter into an ACO structure, now launched as Arizona Care Network.
This ACO encompasses more than 1,200 physicians—300 primary care and 900 specialists—across greater Phoenix. "It took a lot of time [to create the ACO network] because the concepts of the ACA are complex and hard to explain, but these providers are very interested in protocols and taking variation out of clinical care," says Hillard, who is also CEO of Arizona Care Network.
Medicare beneficiaries using ACOs can choose doctors inside or outside of the ACO. The ACOs share with Medicare any savings generated from lowering the growth in healthcare costs, while meeting 33 quality-of-care measures that address coordination, patient safety, prevention, and specialized care for at-risk populations.