First Survey of Public, Commercial ACOs Finds Majority Are Physician-Led

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By Nathaniel Weixel  

June 5 — Despite initial concerns that hospitals would dominate the formation of accountable care organizations, the first survey of public and private ACOs found the majority of the organizations are physician-led.

The results of the National Survey of Accountable Care Organizations, conducted by researchers at the Dartmouth Institute for Health Policy & Clinical Practice, were published in the June edition of the health policy journal Health Affairs.

The survey's findings suggest that moving the health-care delivery system away from fee-for-service won't be accomplished without strong, effective leadership from physicians.

The study, “First National Survey of ACOs Finds That Physicians Are Playing Strong Leadership and Ownership Roles,” compared physician-led ACOs to other types of ACOs and found that physician-led organizations were more likely to have comprehensive care management programs in place and advanced IT capabilities.

They also are more likely to measure and report financial and quality performance at the clinician level and to provide meaningful and timely feedback to clinicians, it said.

The study found that 51 percent of ACOs were physician-led, with 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. Only 3 percent reported being led by hospitals alone, the study found.

Physician Buy-In Critical

Although the physician-led model of accountable care may face greater challenges than other ACOs, the study concluded physician leadership is likely to have a strong influence on how both physicians and patients view the ACO model.

“Physicians' buy-in to payment reform is likely to be critical to the success of the health care reform,” Elliott Fisher, director of the Dartmouth Institute and a co-author of the paper, said in a statement. “The findings suggest that physicians are taking seriously their responsibility to lead change in the health care system on behalf of their patients.”

Previous research has shown that involving physicians in the governance of provider organizations improves communication and builds trust by assuring practicing physicians and clinical staff that their professional values are represented, the study said. Physician governance also assures patients that their needs will be considered along with those of the organization.

Overall, physicians owned the equipment and employed the staff in 40 percent of ACOs. Physicians owned 62 percent of physician-led ACOs, compared with physicians owning 16 percent of other ACOs, the study found.

ACOs aim to improve the quality and lower the cost of health care through several mechanisms, such as disease management programs, care coordination and the alignment of financial incentives for hospitals and physicians. The Affordable Care Act created the Medicare Shared Savings Program (MSSP) for such entities, and private insurers are contracting with providers to form commercial ACOs as well. Over 600 ACOs are operating in the U.S., the study said.

Organization Diversity

The study also documented the diversity of organizations participating in accountable care programs. Some ACOs are made up of only primary care physician practices; some are multispecialty physician practices; and others are integrated delivery systems and include providers across the continuum, such as hospitals and post-acute care providers.

The study concluded that, “[b]ecause it is not yet clear which characteristics and capabilities are important for an ACO's performance, policymakers and payers may need to continue to provide different types of support and contracts to encourage the continued development and success of physician-led ACOs.”

To contact the reporter on this story: Nathaniel Weixel in Washington at

To contact the editor responsible for this story: Brian Broderick at

An abstract of the article is at

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