High Performance Accountable Care: Building on Success and Learning from Experience

What to expect from ACOs and how to ensure their successful implementation

The Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) establishes a new category of provider within the Medicare program—the accountable care organization (ACO)—with rules for provider participation and principles for sharing the savings that ensue from this new form of health care delivery. A broad framework is specified in the law and more details have been laid out in proposed rules released by the Centers for Medicare and Medicaid Services (CMS), but whether the promise of this new payment and delivery model is realized will depend both on the implementation decisions made over time by CMS and the willingness and ability of health care providers, other payers, and the general public to respond to this opportunity to improve the performance of the health care system.

This report by the Commonwealth Fund Commission on a High Performance Health System (Commission): 1) sets forth the rationale for creating ACOs; 2) describes several promising types of ACO models that should be considered and evaluated as part of an effort to facilitate adaptability and spread of accountability for quality and cost to as wide a segment of the U.S. health care delivery system as possible; and 3) concludes with a set of Commission recommendations on what ought to be expected from ACOs and how to ensure their successful implementation and spread, both immediately and over time. Although the Commission’s recommendations are addressed, for the most part, to CMS, the report also is intended to offer information and guidance to providers, payers, and patients who will be forming, and interacting with, ACOs.

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