Organizational Factors Associated With Variation in Primary Care Providers in ACOs

The rapid expansion of the accountable care organization (ACO) program implemented by CMS in 2012 has resulted in different types of health care organizations participating in this value-based payment model.^1,2 The ACO model encourages providers to coordinate patient care across the continuum and financially rewards participants through shared savings for containing costs while improving the quality of care. With heterogeneity in organizational characteristics and structure among ACO participants,³ little is known about what characteristics and structural and environmental factors are associated with the provider composition of Medicare and non-Medicare ACOs.

In Medicare ACO contracts, beneficiaries are often attributed to organizations based on their use of primary care services from eligible providers,^4,5 making primary care important for this advanced payment model. Recently, there has been an increase in the percentage of primary care providers in Medicare ACOs, likely due to recent rapid growth in advanced practice providers who became eligible for beneficiary attribution in 2016.⁶ The percentage of participating specialty providers has decreased, which may reflect ACOs strategically changing their clinician workforce composition to move away from higher-risk and costly patients⁷ in efforts to treat their patients with chronic conditions^8,9 or integrate specialty care into primary care delivery.¹⁰

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