Hot Spots and Ghost Towns: 5 Observations on ACO Proliferation

Accountable care organizations are still in their infancy and states are widely uneven when it comes to ACO development. Some regions have none will others have ACOs reaching the double-digits. Leavitt Partners' Center for ACO Intelligence identified and analyzed more than 160 accountable care organizations in the country in its recent report, "Growth and Dispersion of Accountable Care Organizations." Here are some major findings and trends the team observed in ACO proliferation across the country.

1. Providers are playing a game of follow-the-leader. The location and quantity of ACOs is polarized. While some states have no ACOs, California has 17, Texas and Michigan have 12, Massachusetts has nine and New York has eight. According to the report, a significant amount of ACO growth is reactionary. When one organization forms an ACO, competitors in the marketplace often follow and do the same.  

2. Some states have zero ACO development. While lower-income areas and rural regions are less likely to see many ACOs, there are still entire states that have no ACO development at all. For example, there are zero ACOs in Idaho, Alabama, Georgia, West Virginia, North Dakota, South Dakota and Vermont..

3. Hospitals and hospital systems provide the backbone for most ACOs.
Of the 164 ACOs identified, nearly two-thirds were launched by hospitals or hospital systems. California, Texas and Michigan each contain eight ACOs that are backed by hospitals — the highest figure in the country. Wisconsin and Ohio each have seven.

4. Providers and payors are still investing in ACOs regardless of the Medicare Shared Savings Program. Medicare ACOs are still in the early stages, but ACO growth has continued to grow independent of the federal model. This may accelerate with the release of the final ACO rules last month.

5. There is not one proven model that works best for ACOs. Some organizations operating as ACOs have been working under that model for years. Others have recently adopted a new model to reduce costs and improve quality. According to the report, there is still no consensus as to which models are best. Much about ACOs remains to be firmly defined.

The report's data was based on studies beginning in Sept. 2011. Read the white paper in full here (pdf).

Related Articles on ACOs:

FTC Commissioner: ACOs Have Meager Prospects for Cost Savings
4 Steps to Get Out of ACO Limbo
Economists Wary of ACOs' Ability to Reign in Healthcare Costs




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