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Accountable care organizations (ACOs) are an increasingly dominant feature of the health care delivery system. As of the third quarter of 2019, nearly 1,000 ACOs covered approximately 44 million lives in the United States. Evidence regarding Medicare ACOs and their commercial counterparts indicates these models can achieve savings while meeting quality standards, although savings amounts vary by ACO characteristics.
Given their breadth and their incentives for care coordination, ACOs could be a powerful vehicle for improving palliative and serious illness care. This is because many of the most useful services for people with serious illness, such as 24/7 access to clinical support, home-based services, or caregiver education, are not typically reimbursed (or have small payments) under fee-for-service arrangements, whereas ACOs could receive shared savings for implementing these strategies. Indeed, some ACOs have shown success through exactly this approach. As a whole, though, early research suggested most ACOs were not focused on care management strategies targeting high-risk individuals (for example, those with multiple chronic conditions or high rates of utilization) but rather were focusing on utilization reduction across all patient groups, particularly for inpatient and postacute care.