Challenges and Strategies for Engaging Specialists in Accountable Care Organizations

ACOs Struggle to Engage Specialists in Value-Based Care Initiatives

Accountable Care Organizations (ACOs) are facing challenges in effectively engaging specialists to improve value-based care, despite it being a top priority for the Centers for Medicare and Medicaid Services. A recent study from the Institute for Accountable Care in the American Journal of Managed Care found that the predominant influence of fee-for-service payment structures on specialist behavior was a major hurdle for 58% of ACOs.

The study analyzed 101 Medicare ACOs participating in either the Medicare Shared Savings Program or the Realizing Equity, Access, and Community Health (REACH) ACO model as of 2023. While most ACOs prioritize specialist engagement, less than 10% indicated high levels of engagement in value-based care initiatives.

ACOs are actively seeking to involve specialists in their efforts, with strategies such as integrating them into quality improvement projects and organizing collaborative sessions to establish evidence-based care pathways. Financial incentives play a significant role in encouraging specialist participation, with approximately half of ACOs offering incentives targeting various aspects of performance and behavior.

However, challenges such as a lack of data to evaluate specialist performance and concerns about insufficient resources or bandwidth to effectively address specialist alignment persist. Study author Rob Mechanic emphasized the importance of engaging specialists in dialogue and helping them understand the ACOs’ goals.

While financial incentives were identified as a key factor in encouraging specialist participation within ACOs, Mechanic believes that having a culture of quality and information systems that facilitate collaboration between specialists and primary care providers is essential. Greater transparency regarding specialty costs and outcomes will be critical to facilitating collaborative care delivery between primary care and specialty providers.

Overall, the study highlights the need for ACOs to address the challenges of engaging specialists in value-based care initiatives to improve patient outcomes and reduce healthcare costs.