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Leavitt Partners ACO Survey Reveals Need for Attention to Culture

Thursday, December 3rd, 2015

New survey data is challenging common assumptions about how accountable care organizations (ACOs) develop. Leavitt Partners’ most recent survey of ACO characteristics has revealed some information both payers and policymakers should consider.

For instance, one widely held assumption is that most ACOs would hold an average of three contracts that tied some level of reimbursement to the ACO’s capabilities to better manage care. In fact, however, the data shows the ACO market is divided into the “experimenters” that hold just one contract and the “devout” that hold five or more contracts.

The survey did not reveal any meaningful difference between physician-led ACOs and hospital-led ACOs. Systems with more partners were more likely to have more contracts.

The Leavitt Partners survey data also revealed ACOs with one commercial contract that are looking to expand are more likely to consider contracting with Medicare over choosing Medicaid or pursing another commercial contract. Not surprisingly, respondents expressed more interest in the Medicare Shared Savings Program than other Medicare ACO models. Only ACOs with four or more existing contracts indicated they were ready to take on two-sided risk or capitation.

According to the latest data from the Accountable Care Learning Collaborative (ACLC) database, the current source of ACO contracts is:

  • Commercial-only ACO contracts – 32.9%
  • Government-only ACO contracts – 46.6%
  • Commercial and government ACO contracts – 18.5%
  • ACOs without any contracts – 2.1%

Furthermore, a majority of the ACOs surveyed by Leavitt Partners cited physician engagement as their single largest challenge. This was followed by problems associated with implementation of a quality improvement plan. Other noted challenges included physician inattention to costs and the difficulty of patient engagement. These challenges can delay and block the ability of ACOs to deliver steady performance on quality and cost efficiency.

Success as an ACO depends upon the formation of a dominant culture in an integrated organization that delivers both clinical quality and service delivery effectiveness. If third-party payers wish to see an enhanced ability on the part of ACOs to take on financial risk and be successful, they should look for validation of both sound formation and integrated operations from potential ACO contractors.

URAC’s Clinical Integration and Accountable Care accreditation standards exist to validate just these types of internal functions and operations. Adherence to URAC standards helps prove existing accountable care organizations’ commitment to quality. They can assist clinically integrated networks that are forming as well as validate existing integrated networks that are growing into ACOs.


For 25 years, URAC has been the independent leader in promoting health care quality through accreditation, education, and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of health care.

For more information about URAC, contact us.

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