ACO Participation Nearly Quadrupled Over 18 Months

Premier, Inc., a health care improvement company, published an economic outlook report for Accountable Care Organizations (ACOs) and population health management (PHM) trends within the United States. The report, which is based on a survey of 101 hospitals across 35 states, demonstrates that ACOs and PHM are quickly gaining ground as a new model of health care delivery, as ACO participation has nearly quadrupled since spring of 2012.


According to the report, ACOs allow health care providers to take more responsibility for “the health of a defined population.” Providers are then able to coordinate health care over numerous settings, and are required to meet identifiable levels of health care quality and cost. The purpose is to deliver high-quality care, with better outcomes, increased patient satisfaction, and improved PHM, while lowering health care costs. Currently, there are an estimated 500 ACOs within the United States.

The report focuses on the types of health care providers creating ACOs; provider locations and structures; how long it will take for new ACOs to emerge; and what investments and partnerships are being explored for ACO participation.

Key Findings

Hospital ACO participation was at 4.8 percent in the spring of 2012, but has now increased to 18 percent of hospitals. In addition, ACO participation is expected to increase further, as 76.5 percent of survey respondents disclosed that their hospitals expect to participate in the future.

Although participation has increased significantly, the report found that some providers are being cautious with starting ACO participation. In 2012, over 50 percent of respondents projected their hospitals would participate in an ACO by the end of 2013. However, only about 25 percent will actually meet that projection. Results demonstrated that large hospitals are moving more quickly than small hospitals in ACO participation. Further, while non-rural hospitals and integrated delivery network hospitals were found to be more likely to participate in ACOs, rural hospitals and “standalone” hospitals were found to be least likely to participate.

The report also noted that whether or not providers anticipate participation in ACOs, they are taking steps toward that direction. Specifically, hospitals are investing in health information technology and nontraditional forms of care, such as “lifestyle and wellness coaching, virtual care and patient-centered medical homes,” which are imperative to the new health care model. Further, hospitals are starting to create new partnerships with large employers, external providers, private and public payers, and local health departments, which will help with the costs of transitioning to accountable care.