The Commonwealth Fund has released a brief examining private sector accountable care organizations’ (ACO) experiences implementing shared payer-provider risk payment models.  Noting that the national health care reform law implements such a model under the Medicare Shared Savings Program, the brief posits that providers currently lack the necessary infrastructure to successfully assume and manage risk.  The authors conclude that providers need improved data and analytic capabilities to negotiate appropriate risk-sharing arrangements with payers and adequately manage risk for affected patient population.

From the report: 

The Medicare Shared Savings Program, a component of the Patient Protection and Affordable Care Act, has accelerated the creation of accountable care organizations (ACOs), payer–provider alliances meant to deliver lower-cost but still high-quality health care via new payment models, particularly ones that reward efficiency. This paper describes and reports on the implementation of eight private ACOs that use, or are planning to deploy, a shared payer–provider risk payment model. Still in an early developmental phase, these payment models vary not only in their design and in how they define shared risk. The authors note that providers currently lack the infrastructure required to take on and manage risk successfully, though some payers are providing such support. Providers will need more data and analytic capabilities to manage the patient populations for which they take on financial risk and to negotiate appropriate risk-sharing arrangements with payers.

Full report: Promising Payment Reform: Risk-Sharing with Accountable Care Organizations (PDF | 568.48 KB)

Commonwealth Fund.  (2011).  Promising payment reform: risk-sharing with accountable care organizations.  Delbanco, S.