The first national survey of accountable care organizations (ACO) examines who is playing the strongest leadership and ownership roles in the development of these new models of care.
The survey results, published last month in Health Affairs, found that more than one-half of surveyed ACOs are physician-led, and one-third are jointly led by physicians and hospitals. In more than three-quarters of ACOs, physicians constituted a majority of the governing board. Physicians also owned 40 percent of ACOs.
The study noted that the health care climate is shifting to population-based care models like ACOs, requiring major changes that will impact physicians’ incomes, degrees of autonomy, work environments and clinical routines.
“Physicians’ buy-in to these changes is likely to be critical,” the survey results said. “Previous research has shown that involving physicians in the governance of provider organizations improves communication and builds trust by assuring practicing physicians and clinical staff that their professional values are represented when key organizational decisions are made.”
According to the survey, physician-led organizations had more individual medical groups than other types of ACOs, indicating that at least some of these organizations consist of independent practice associations or physician-owned practices. More than one-third of physician-led organizations consisted solely of physician practices, compared to 6 percent of other types of ACOs.
Fifteen percent of physician-led ACOs were participating in the Advanced Payment Program, which the AMA was instrumental in securing from the Centers for Medicare & Medicaid Services. This model provides start-up capital to physician-led organizations and rural groups. Allowing physicians in all practice settings and sizes to participate increases the number of Medicare ACOs and maximizes the benefits for patients, physicians, taxpayers and the Medicare system as a whole.
As part of its Professional Satisfaction and Practice Sustainability initiative, the AMA is identifying effective care delivery and payment models and developing solutions for physicians in practices of all sizes.
The AMA Innovators Committee, an advisory group of physicians with real-life experience implementing innovative delivery and payment models in their own practices, has created resources and webinars to share their learnings. Physicians can use the resources to guide them in setting up a physician-led, integrated health care delivery group, such as an ACO.
In addition, physicians who are part of or working toward multi-specialty physician-led integrated health care delivery groups can join the AMA Integrated Physician Practice Section (IPPS). The section seeks to influence medical policy and regulations around the integrated practice model and provides a way for physicians to share their experiences with integration.
