This research brief from the National Institute for Health Care Reform describes experiences with accountable care organizations that can help inform the development and implementation of various ACO models as part of national health care reform.  The research brief is based on key informant interviews with individuals from health care organizations:  Billings Clinic (Billings, MT), Carilion Clinic (Roanoke, VA), Physician Health Partners (Denver, CO), ProHealth Physicians (CT), Sharp HealthCare (San Diego, CA), UniNet (Omaha, NE) and Westshore Family Medicine/Mercy Health Partners (Muskegon, MI).

Although varied in size and structure, all these organizations were implementing improvements in care delivery processes, including improved care coordination and management of patients with chronic conditions. Many are using case managers and patient navigators (usually nurses) for these improvements.

In addition, all are investing in organizational infrastructure improvements such as registries, electronic medical records, data warehouses, and financial incentives for achieving performance goals.

Among the common challenges faced by these organizations were identifying funding for the improvements, staff/provider resistance to change, temporary disruptions to productivity while new systems are implemented, and limited organizational infrastructure to support the changes.  Successful strategies have been enhancing physician involvement at both the leadership and line level, aligning payment and other financial incentives, and finding infrastructure support from better-resourced partners such as hospitals, independent practice associations, and other networks.

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