Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA.
Health Aff (Millwood). 2012 Nov;31(11):2368-78. doi: 10.1377/hlthaff.2012.0544.
The implementation of accountable care organizations (ACOs), a new health care payment and delivery model designed to improve care and lower costs, is proceeding rapidly. We build on our experience tracking early ACOs to identify the major factors-such as contract characteristics; structure, capabilities, and activities; and local context-that would be likely to influence ACO formation, implementation, and performance. We then propose how an ACO evaluation program could be structured to guide policy makers and payers in improving the design of ACO contracts, while providing insights for providers on approaches to care transformation that are most likely to be successful in different contexts. We also propose key activities to support evaluation of ACOs in the near term, including tracking their formation, developing a set of performance measures across all ACOs and payers, aggregating those performance data, conducting qualitative and quantitative research, and coordinating different evaluation activities.
责任医疗组织（ACO）的实施正在迅速推进，这是一种新的医疗保健支付和交付模式，旨在改善医疗服务和降低成本。我们借鉴了我们在跟踪早期 ACO 方面的经验，以确定可能影响 ACO 形成、实施和绩效的主要因素，如合同特征、结构、能力和活动以及当地背景。然后，我们提出了如何构建 ACO 评估计划，以指导政策制定者和支付者改进 ACO 合同的设计，同时为提供者提供有关在不同情况下最有可能成功的护理转型方法的见解。我们还提出了支持 ACO 近期评估的关键活动，包括跟踪其形成、为所有 ACO 和支付者制定一套绩效衡量标准、汇总这些绩效数据、进行定性和定量研究以及协调不同的评估活动。
