California Sees Care Quality Gains as ACOs Grow in Size, Capabilities
Research suggests that as California's accountable care organizations have become more established, they have improved quality of care in the state, according to a blog post published in Health Affairs.
The blog post was written by Steven Shortell, dean of UC-Berkeley's School of Public Health, and Richard Scheffler, distinguished professor of health economics and public policy at UC-Berkeley's School of Public Health and Goldman School of Public Policy.
Effect of ACOs
According to the blog post, California has 67 ACOs -- more than any other state.
Enrollment in those ACOs is expected to jump by about 48% over the next two years, according to a report released in February by the Berkeley Healthcare Forum at UC-Berkeley's School of Public Health. As a result, California is approaching a goal that seeks to provide integrated care to 60% of the state population by 2022.
In addition, ACOs are expected to cut the percentage of California's health care spending through fee-for-service models from 78% to 50% by 2022.
Meanwhile, medical groups that have ACO contracts have been found to report higher patient satisfaction scores and higher scores for care, compared with groups that do not participate in ACOs.
The Berkeley Forum report cited six factors that distinguish higher-performing ACOs, including:
- Care management capabilities;
- Electronic health record functionality;
- Effective partnerships;
- Patient and family engagement;
- Size of the organization; and
- Standardized and transparent measurement.
According to the blog post, ACOs still face several barriers to ensuring high-quality integrated care. For example:
- Comparing performance among ACOs is difficult because of a lack of an All Payer Claims Database;
- Creating integrated care systems requires significant resources and improved EHR functionality, as well as better workflow designs and stronger partnerships; and
- Questions remain as to whether ACOs can "stay the course" under current managerial and clinical leadership as more demands are placed on the organizations (Shortell/Scheffler, Health Affairs, 6/2).