Valerie A. Lewis (
Thomas D'Aunno is a professor of management and director of the Health Policy and Management Program at the Robert F. Wagner Graduate School of Public Service, New York University, in New York City.
Health Aff (Millwood). 2018 Feb;37(2):292-298. doi: 10.1377/hlthaff.2017.1025.
Accountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs. We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94 percent had data services provided by the partner, 87 percent received administrative services, 68 percent received educational services, and 66 percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.
问责制医疗组织（ACO）通常被认为是由医生、医院和其他医疗服务提供者推动的。然而，由于 ACO 合同具有灵活性，管理组织也可能成为 ACO 的合作伙伴。我们使用了 2013 年至 2015 年全国问责制医疗组织调查中 276 个 ACO 的数据，以了解非提供者管理伙伴参与 ACO 的普遍程度、这些伙伴提供的服务以及拥有此类伙伴的 ACO 的结构。我们发现，37%的 ACO 报告有管理伙伴，其中三分之二的 ACO 报告说，合作伙伴分担了财务风险或回报。在有伙伴的 ACO 中，94%的 ACO 获得了伙伴提供的数据服务，87%的 ACO 获得了行政服务，68%的 ACO 获得了教育服务，66%的 ACO 获得了护理协调服务。一半的 ACO 从其伙伴那里获得了所有这四项服务。有伙伴的 ACO 比其他 ACO 更注重初级保健。在医疗保险 ACO 计划中，有和没有伙伴的 ACO 在成本和质量方面的表现相似。我们的研究结果表明，管理伙伴在许多 ACO 中发挥着核心作用，可能为规模较小且由医生管理的 ACO 提供服务或专业知识，这些服务或专业知识被认为是 ACO 成功所必需的。
