Surprisingly Strong Level of Physician Leadership in ACOs

The first national survey of Accountable Care Organizations (ACOs) found physicians are playing strong leadership roles, which can influence how effective the organization is at improving quality and costs, according to a new study.

In an article published in Health Affairs, lead investigator Carrie Colla, PhD, and colleagues reported that just over half (51%) of ACOs were physician led, while another third were jointly led by physicians and hospitals. The researchers also found that in 78% of ACOs, physicians constituted a majority of the government board.

“The broad reach of physician leadership in ACOs has important implications for the future of healthcare reform,” Colla, an assistant professor at the Geisel School of Medicine, Dartmouth College, and the Dartmouth Institute for Health Policy and Clinical Practice, said in a statement. “A central role for physicians in the leadership of ACOs is likely to have a powerful influence on how both physicians and patients view the ACO model.”

According to the study results, physician-led ACOs were more likely to have comprehensive care management programs in place and advanced IT capabilities. These ACOs were also more likely to provide meaningful and timely feedback to clinicians. Physician-led ACOs were also more likely than other types of ACOs to measure and report financial and quality performance at the clinician level.

“Physicians’ buy-in to payment reform is likely to be critical to the success of the health care reform,” said Elliott Fisher, MD, MPH, Director of the Dartmouth Institute and a co-author on the paper. “The findings suggest that physicians are taking seriously their responsibility to lead change in the health care system on behalf of their patients.”

The study also found diversity among the organizations participating in ACO programs. While some were made up of only primary care physician practices, some ACOs were integrated delivery systems that included hospitals and post-acute care providers.

“The broad reach of physician leadership has important implications for the future evolution of ACOs,” the authors wrote. “It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians.”