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Lessons from the Field: Making Accountable Care Organizations Real

Changing Care Delivery RequiresSubstantial Investment of Time and Money

News Release
Jan. 20, 2011

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—An examination of provider efforts to improve patient care illustrates that changing care delivery requires substantial investments—both time and money—even among groups of providers affiliated with one another for many years, according to a new study conducted by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Policy makers hope that the development of accountable care organizations (ACOs)—organized groups of physicians, hospitals or other providers jointly accountable for caring for a defined patient population—can improve health care quality and efficiency by changing how patient care is delivered. Although there is considerable interest in ACOs, there has been limited experience with arrangements, organizational structures and care-delivery models similar to what ACOs might constitute.

The study focused on the care-improvement activities of seven provider organizations: the Billings Clinic, Billings, Mont.; the Carilion Clinic, Roanoke, Va.; Physician Health Partners, Denver; ProHealth Physicians, Farmington, Conn.; Sharp HealthCare, San Diego; UniNet, Omaha, Neb.; and Westshore Family Medicine/Mercy Health Partners, Muskegon, Mich. The study examined activities that future ACOs are likely to undertake to be successful, such as improved coordination of care for people with chronic conditions; the challenges confronted by the organizations; and the ways those challenges were addressed.

“Even for large, sophisticated provider organizations, changing care delivery is challenging and requires substantial financial and time investments,” said Paul B. Ginsburg, Ph.D., HSC president and NIHCR research director, who coauthored the study with Timothy K. Lake, Ph.D., and Kate A. Stewart, Ph.D., both researchers at Mathematica Policy Research.

Based on telephone interviews with 34 people between March and May 2010 who either worked in or were affiliated with the seven organizations, the study’s findings are detailed in a new NIHCR Research Brief—Lessons from the Field: Making Accountable Care Organizations Realavailable here.

While the activities studied are not unique to the seven organizations, many of the changes pursued by these or other large provider organizations are unusual among the many small, independent physician practices that still provide a large portion of patient care in the United States, according to the study.

All of the organizations studied were engaged in multiple efforts to improve care coordination and quality of care—activities likely to be pursued by ACOs. The activities generally fell into two categories: 1) interventions to improve care delivery; and 2) investments in infrastructure or other organizational changes to encourage or facilitate care delivery improvements. And, the clinicians within the organizations studied generally have had long-standing affiliations with one another.

Even though each organization faced different challenges to care delivery and infrastructure improvements, some of the challenges faced were nearly universal, including financing new efforts, addressing staff concerns and productivity problems during implementation, and developing appropriate and sustainable infrastructure to support improvement efforts.

To overcome challenges, organizations typically developed multifaceted strategies, including use of physician leaders and more open lines of communication to engage and reassure staff, enhanced financial incentives, and infrastructure support.

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The National Institute for Health Care Reform contracts with the Washington, D.C.-based Center for Studying Health System Change to conduct high-quality, objective research and policy analyses of the organization, financing and delivery of health care in the United States. The nonprofit, nonpartisan Institute was created by the International Union, UAW; Chrysler Group LLC; Ford Motor Company; and General Motors to help inform policy makers and other decision-makers about options to expand access to high-quality, affordable health care to all Americans.


The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research, Inc.



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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.