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How health plans and employers are using episodes of care to maximize their contracts with ACOs

By Marc Rothman, MD and Tami Hutchison on 4/21/21 10:42 AM

Health plans and employers are increasingly contracting directly with Accountable Care Organizations (ACOs) in hopes of lowering the cost of care provided to plan members and improving health outcomes. Unfortunately, ACOs have a problem: Although they have proved to be a vital component in the movement toward value-based care, ACOs rely extensively on their primary care members to drive value improvement, and primary care physicians can only influence a portion of the health plan spend — estimated to be 40%. The challenge ACOs share across all their risk arrangements is how to create tighter incentive alignment between the ACO and its PCPs -- and the downstream medical/surgical sub-specialists they rely on — to achieve increasingly more value, and assume increasing amounts of risk on both an upside and downside basis.

Topics: Accountable Care Organizations