Survey of twelve children’s hospital-based accountable care organizations

Abstract

Accountable care organizations (ACOs) are a primary focus of value-based healthcare reform strategies, however research is lacking on pediatric-specific ACO development. To present the current landscape of children’s hospital-based pediatric ACOs, researchers conducted semi-structured telephone interviews with executive-level staff from twelve ACOs from November 2013 to February 2014. Interview questions spanned five topics: (1) pathway/strategy; (2) organizational structure; (3) shared savings; (4) provider network; (5) data and quality. Three qualitative frameworks were applied to assess the degree of similarity among pediatric ACO models and between these and promulgated adult ACO components: (1) operational diagrams; (2) spectrums of characteristics; (3) financial and organizational categorization. Organizational structures consisted of five Physician-Hospital Organizations, two System-Based Pediatric Contracts, three Provider-Sponsored Managed Care Organizations, and two Hospital Medical Staff Organizations. Oversight models developed for the ACOs included six separate boards, two board subcommittees, and one dispersed governance. Financial contracts between payers and participants included four shared savings only, one risk corridor, and seven full capitation. Eight participants had provider incentive programs primarily for cost reductions. Nine participants used National Committee for Quality Assurance (NCQA)’s Healthcare Effectiveness Data Information Set (HEDIS) metrics, emphasized utilization management, and invested in separate care coordination resources. Overall, marked variation in pediatric ACO models is developing nationally, and cost savings goals exceed the importance of quality improvement. National pediatric collaboration and state facilitation for ACO quality measures is crucial to improving health outcomes in the pediatric ACO.