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First Survey of ACOs Reveals Surprising Level of Physician Leadership

June 2, 2014
by John DeGaspari
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Physician leaders are seen as an important factor in initiatives to care quality and lower costs

A new study by the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H., reveals the central role of physician leadership in the first wave of accountable care organizations (ACOs), despite early concerns that the economic strengths of hospitals would lead them to dominate ACOs.

The study was published in the June issue of Health Affairs.

In the first analysis of the National Survey of ACOs, the research team found that the majority of ACOs identified as physician led, with another third jointly led by physicians and hospitals. Over 600 ACOs are now operating in the U.S.

The study compared physician-led ACOs to other types of ACOs and found that physician-led ACOs were more likely to have comprehensive care management programs in place and advanced IT capabilities. They are also more likely to measure and report financial and quality performance at the clinician level and to provide meaningful and timely feedback to clinicians.

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, while others are integrated delivery systems and include providers across the continuum, such as hospitals and post-acute care providers.

From October 2012 to May 2013, the researchers fielded the National Survey of Accountable Care Organizations, an annual longitudinal survey of all U.S. organizations with ACO contracts in place or under negotiation, both with public and/or private payers. According to the article’s abstract, they found that 51 percent were physician-led, with another 33 percent jointly led by physician and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs.

“The broad reach of physician leadership in ACOs has important implications for the future of health care reform”, said Carrie Colla, Ph.D., lead investigator of the study, in a prepared statement. “A central role for physicians in the leadership of ACOs is likely to have a powerful influence on how both physicians and patients view the ACO model.”

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