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Accountable care organizations (ACOs) cannot, and should not, hide from downside risk. Despite the ongoing kerfuffle between CMS’s (Centers for Medicare and Medicaid Services) push for downside risk and the threat of mass exodus by early ACO adopters, downside risk is proving fruitful and gaining momentum.
Admittedly, ACOs have legitimate reasons for hesitating. In addition to recent mixed signals from CMS, success with downside risk takes time to realize. There are considerable upfront costs across technology, care coordination, education and infrastructure. Most notably, accountability requires data and the ability to share, interpret and put resulting insights into continuously evaluated and refined actions.
However, pressure to accept downside risk is mounting as risk-bearing organizations experience success across commercial and Medicare populations. Even the most risk-adverse organizations cannot escape much longer.