Factors That Distinguish High‐Performing Accountable Care Organizations in the Medicare Shared Savings Program

Objective

To identify factors that promote the effective performance of accountable care organizations (s) in the Medicare Shared Savings Program.

Data Sources/Study Setting

Data come from a convenience sample of 16 Medicare Shared Savings s that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high‐performing and three low‐performing s.

Study Design

Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of performance.

Data Collection Methods

A total of 16 s were first rank‐ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content‐analyzed.

Principal Findings

Results identify several factors that distinguish high‐ from low‐performing s: (1) collaboration with hospitals; (2) effective physician group practice prior to engagement; (3) trusted, long‐standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators.

Conclusions

Shorter interventions can improve performance—use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician–hospital collaboration and skills of physician leaders. and other stakeholders need realistic timelines for performance.