Management partners may be a major driver of ACO activity

Thirty-seven percent of accountable care organizations (ACOs) had a management organization as a partner between 2013 and 2015. While the arrangement didn’t appear to improve an ACO’s ability to meet performance targets, their services and start-up funding may have enabled more practices to participate in accountable care.

The study, led by Dartmouth University health policy professor Valerie Lewis, PhD, MA, and published in the February 2017 issue of Health Affairs, examined survey data from 276 ACOs from 2013 to 2015. Of the 37 percent of ACOs which had a management partner:

• 67 percent had that partner sharing in the risk and rewards of the ACO.
• 94 percent received data analytics services from the partner.
• 87 percent received administrative services.
• 68 percent received educational services.
• 66 percent received care coordination services.
• 50 percent received all four of services listed above.
• Were more likely to be composed of only physician groups, have a Medicare contract and have a higher proportion of primary care physicians.

“Our results do suggest that outpatient, physician-based ACOs are considerably more likely to work with a management partner than are ACOs with hospitals,” Lewis and her coauthors wrote. “It is possible that management partners are helping more physician groups participate in ACO programs than would otherwise be the case, which may lend some credence to the phrase commonly used in the industry: Management partners serve as ‘ACO enablers.’”

The help of a management partner, however, didn’t impact cost and quality performance among Medicare ACOs. While a higher percentage of ACOs with a partner did achieve savings in their first year compared to ACOs without a partner (24 percent vs. 17 percent), that difference was erased by the second year. The mean quality composite score between partner and no-partner ACOs was nearly the same in both the first (62 vs. 64) and second years (67 vs. 68).

There could be negative impacts from the involvement of management organizations, such as a situation where its fees outweigh the benefits of the services they’ve provided. Generally, however, the study indicated these partners have been a “major driver” of ACO activity, allowing those with limited assets to get a start in accountable care in place of other support for the capital and technical expertise costs.

“While management partners may exert negative influences on an ACO’s autonomy, it is likely that without these partners, there would be far fewer ACOs in the United States today,” Lewis and her coauthors concluded. “It will be important to continue to track the development of management partners and their net impact on performance as ACOs continue to grow and evolve.”