Accountable Care Organizations

An accountable care organization is a group of health care providers who work to coordinate care for patients and have the potential to improve care delivery and reduce costs. Provider reimbursement is tied to quality measures and reductions in the cost of care.

What are ACOs?

Accountable Care Organizations (ACOs) were authorized under the Affordable Care Act to help transition the U.S. health system from volume-based to value-based care. An ACO is a group of health care providers who work to deliver coordinated care for a defined population and are collectively accountable for the cost and quality of care. Effective ACOs have the potential to promote care coordination among providers and health systems, improve care delivery, and reduce costs.

The Role of Pharmaceuticals in ACOs

Medications play a vital role in helping patients manage their health, particularly for those with chronic illnesses. Therefore, optimizing medication use among ACO enrollees can help providers achieve improved patient outcomes and meet the cost and quality benchmarks for which they are accountable.

In a study published in 2017, NPC and Leavitt Partners surveyed 49 ACOs to assess if and how they were optimizing medication use among their enrollees. The survey had several key findings:

  • Compared with 2012 data, ACOs that participated in this study continued to build effective strategies to optimize medication use.
  • Surveyed ACOs struggled with both notifications related to prescription use and measurement of the influence of optimized medication use on costs and quality outcomes.
  • More ACOs were involving pharmacists directly in care, expanding the use of generics, electronically transmitting prescriptions, identifying gaps in care and potential adverse events, and educating patients on therapeutic alternatives (compared with a previous study).
  • ACO-level policies that facilitate practices to optimize medication use are needed.

Looking ahead, there are several opportunities to improve medication use in accountable care. In 2020, NPC sponsored the Accountable Care Learning Collaborative’s Committee on Medication Optimization. The committee developed helpful new resources, including a Case Study Brief and a Competency Orientation Guide that summarize key strategies successful ACOs have employed to optimize medication use and improve care delivery.

ACO Best Practices Case Studies

In conjunction with seven provider organizations, NPC and its partners, The American Medical Group Association (AMGA) and Premier, Inc., developed a framework to better understand the role of pharmaceuticals in achieving success in a value-based ACO model.

To address gaps discovered in implementation readiness, NPC and its partners developed four ACO case studies highlighting best practices.