How ACOs Are Caring for People with Complex Needs

Peck, K , Usadi, B , Mainor, A , Newton, H , Meara, E
Publication Year: 2018
Patient Need Addressed: Behavioral health, Care Coordination/Management, Chronic Conditions, Substance Use
Population Focus: Complex care
Demographic Group: Adult
Intervention Type: Service redesign
Study Design: Other Study Design
Type of Literature: Grey

Issue: With an incentive to provide high-quality care while controlling costs, accountable care organizations (ACOs) may focus on patients who require the most resources and are most at risk for encountering serious problems with their care. Understanding how ACOs approach care for complex patients requires examination of their organizational strategies, contracting details, and leadership structures. Goals: Describe the specific strategies employed by ACOs that have comprehensive care management programs and processes for complex patients. Methods: Cross-sectional descriptive analysis of the fourth wave of the National Survey of ACOs. Key Findings: Most ACOs report having comprehensive chronic care management processes or programs in place to manage people with complex needs. More labor-intensive interventions, however, are rare. Few ACOs report having advanced programs for engaging patients, in-home visits after hospital discharge, or evidence-based services for patients needing mental health or addiction treatment. Conclusion: While ACOs have increased their efforts to target populations with complex care needs, there is a need for more varied approaches to improving care delivery.

Insights Results

Overview of report

  • Accountable Care Organizations (ACOs) have increased their efforts to target populations with complex care needs but opportunities for improvement remain
  • The findings suggest there is an opportunity for further collaboration between behavioral health providers, social service agencies, health systems, and payers to more fully address the needs of complex patients
    Methods of report
  • The most recent National Survey of ACOs was conducted by SSRS from July 20, 2017, to February 15, 2018. The survey was completed online by most respondents (77%). A paper survey with a subset of questions also was provided to potential respondents in December 2017 and again in January 2018
  • After screening out ineligible and overlapping organizations, the study sample included an estimated 862 ACOs; the authors contacted an average of 3.2 potential respondents at each organization. The study’s outreach methods included email, phone calls, and physical mailings


    • Most ACOs (63%) reported having comprehensive care management programs
    • ACOS were stratified into 3 strategies important for the care of complex populations: 1) Patient identification; 2) Patient engagement; and 3) Care transitions
    • Over half (52%) of ACOs reporting comprehensive care management programs say that they have an advanced system in place to identify and target patients using predictive risk stratification. Moreover, 66% of ACOs with comprehensive care management reported using patient segmentation, categorizing high-risk patients into subgroups based on common needs (e.g., frailty, mental needs, combination of chronic conditions)
    • On the other hand, only 38% of ACOs with comprehensive care management had clinicians trained in patient activation and engagement. Additionally, only 38% of ACOs with comprehensive care management had clinicians that encourage ACO patients to be actively involved in decisions
    • Few ACOs (21%) with comprehensive management report using in-home follow-up visits within 72 hours of discharge with an even smaller percent age (11%) reporting that most or all patients receive that in-home visit
    • Processes facilitated through technology or automation were more common in ACOs in strategies used to reduce risk of hospital readmission
    • It is more common for ACOS with comprehensive care management programs to have Medicaid ACO contracts (compared to Medicare and commercial markets)
    • ACOs with comprehensive care management programs are more likely to implement strategies intended to address behavioral health needs (e.g., anxiety)

    Key takeaways/implications

    • There are many opportunities for ACOs to increase uptake of evidence-based strategies to address the needs of complex populations
    • More research is needed to understand the value of more labor-intensive and costly programs (e.g., one-on-one care transitions, integration of physical and behavioral health services) and the outcomes of those programs, and how ACOs could accelerate the adoption of such strategies