Research: Private-Payer ACOs Larger, More Advanced than Public Counterparts

The perception that most accountable care organizations (ACOs) are following Medicare’s lead might be inaccurate, according to recent research. 

Led by Valerie Lewis, Ph.D, an assistant professor of health policy and clinical practice at the Dartmouth Institute, a group of researchers examined ACOs in both private payer and public payer models. They used an analysis of the National Survey of Accountable Care Organizations to determine that private payer-led models include more downside risk and upfront payments. 

While two-thirds of ACOs had a contract with Medicare, more than the 50 percent who had one with a private payer, those in the private payer model were more likely to featured an integrated delivery system (69 percent vs. 36 percent), a hospital (72 percent vs 53 percent), and higher care management capabilities (38 percent vs 28 percent). There were also more physicians and specialists in a private payer ACO contract.

Those in private models were more likely to have pay-for-performance initiatives (97 percent vs 85 percent), such as patient centered medical homes, public reporting (92 percent vs 80 percent) and risk-based contracts (83 to 55 percent). Most ACOs (57 percent) had only one payer contract, according to the researchers’ findings.

The findings were published in the American Journal for Managed Care.