Key Elements to Consider in ACO Agreements

The Health Care Transformation Task Force released a memo – “Key Elements to Consider in ACO Agreements” – intended to be an educational resource for the health care community and focuses on contracting strategies in three main areas: patient experience and access; cost; and quality of care.

Key highlights include:

  • Patient Experience and Access – The memo identifies practical contracting strategies to promote patient centeredness, including a focus on the importance of a primary care relationship, coordination and communication, access to timely care, and best practices for care management. To establish a successful ACO, the memo highlights the importance of selecting a designated population with a sufficient or adequate number of patients and calls for a robust information exchange that drives transparency and accountability.
  • Cost – The memo’s cost section focuses on the financial models necessary for a successful ACO, including whether the model should be based on historical claims experience or community ratings and local cost trends. It stresses that effective ACO contracts should clearly define the financial responsibility between the purchaser, payer, provider and/or patient. Additionally, parties entering into contracts should have a well-defined benchmark or global budget and performance period. As circumstances may change over time, contracts should allow for ongoing access to data and periodic reviews to make necessary adjustments.
  • Quality of Care – The memo also focuses on clinical management and models of care, outlining the importance of establishing whether clinical management will lie with one source or be shared among multiple stakeholders. The authors share insights for setting and monitoring key quality measures to ensure patients always have access to necessary care.

Download the Memo