Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers who come together to provide coordinated, high-quality care to their patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves. Governance of an ACO involving pediatric care must include equitable representation of pediatric primary and specialty care.
Payment and Reform
The Academy has produced the following statements related to payment and reform:
Pediatric Accountable Care Organizations: Insight From Early Adopters
The AAP collaborated with Leavitt Partners, LLC, to carry out a study of pediatric ACOs, including a series of 5 case studies of diverse pediatric models, a scan of Medicaid ACOs, and a summit of leaders in pediatric ACO development. These collaborative activities identified several issues in ACO formation and sustainability in pediatric settings and outlined a number of opportunities for the pediatric community in areas of organization, model change, and market dynamics; payment, financing, and contracting; quality and value; and use of new technologies. These insights can guide future work in pediatric ACO development.
Accountable Care Organizations (ACO) and Pediatricians: Evaluation and Engagement
As we enter the age of Accountable Care Organizations (ACOs), the Academy has produced guidance for members on factors to consider in evaluating an opportunity to participate in an ACO's
Joint Principles for Accountable Care Organizations Released by Organizations Representing More Than 350,000 Primary Care Physicians
Four physician membership organizations released "Joint Principles for Accountable Care Organizations" (ACOs). Care delivered through ACOs may help improve quality of care, increase efficiency, and reduce overall health care spending
AAP Policy Statement: Principles of Health Care Financing (2017)
Access to care depends on the design and implementation of payment systems that ensure the economic viability of the medical home; support and grow the professional pediatric workforce; promote the adoption and implementation of health information technology; enhance medical education, training, and research; and encourage and reward quality-improvement programs that advance and strengthen the medical home.
A New Era in Quality Measurement: The Development and Application of Quality Measures
This policy statement provides an overview of quality measurement and describes the opportunities for pediatric health care providers to apply quality measures to improve clinical quality and performance in the delivery of pediatric health care services.
Frequently Asked Questions
The AAP continues to develop resources for members to assist in their understanding of the various payment methodologies, as well as advocate for appropriate payment for pediatric services.
Frequently Asked Questions About Accountable Care Organizations
Alternative Payment Strategies: Must-know Definitions PDF (122.98 KB) (Catalyst Center)
Additional AAP Resources
Key considerations that primary care pediatricians and pediatric specialists need to ask when assessing whether to join an ACO.
Gainsharing and Shared Savings: Among the various forms of payment reform are gainsharing and shared savings. Both offer the potential of enhanced payment for meeting established clinical, quality and/or financial targets. However there are potential risks as well. The following offers clarification and guidance on these two topics as well as resources for those considering participating in these types of payments.
AAP Policy Statement: Application of the Resource-Based Relative Value Scale System to Pediatrics (2014)
With an increased focus on payment and productivity measurement in health care, it is essential to understand the genesis and principles behind the Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule. The majority of third-party payers, including a growing number of Medicaid programs and commercial payers, use variations of the Medicare RBRVS as their basis for physician payment.