Physicians leading the way on ACOs, but challenges remain, national survey finds

Physicians have taken an active leadership role in the nation’s accountable care organizations (ACOs), according to the first-ever national survey of ACOs.

The survey results, published in the June 2014 issue of Health Affairs, found that 51% of ACOs are physician-led and another 33% are operated jointly by physicians and hospitals. More than three-fourths of ACOs have a majority of physicians on their governing board, and 40% are physician-owned.

In spite of initial concerns about potential hospital dominance, physicians are at the forefront of leadership in the early implementation of the ACO payment and delivery model,” write the survey authors.

While the authors cite potential challenges for physician-led ACOs-specifically coordinating care between care settings and developing health information technology infrastructure-they argue that physician leadership is vital to the care model’s future success. The authors say that lessons learned from the managed-care movement in the 1990s showed that physician leadership is essential if physicians are “expected to serve both their patients and the financial interest of their organization.

“It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians,” they write.

The survey also identified key components of physician-led ACOs, including:

• They are less likely to include hospitals and other types of providers, and

• They are less likely to offer services traditionally segregated from medical care, such as behavioral health and pharmacy

Physician-led ACOs are also significantly less likely to participate in contracts that include downside risk, according to the survey results, compared with hospital-led ACOs or other arrangements. Only 22% of physician-led ACOs had risk-based contracts, compared with 48% of non-physician-led ACOs.

The survey data was collected between October 2012 and May 2013 from 292 ACOs, of which 173 organizations completed the survey.