Building ACOs and Outcome-Based Contracting in the Commercial Market: Provider and Payor Perspective

This Taconic Health Information Network and Community (THINC) report, supported by NYHealth, looks at the concerns and opportunities for health providers and commercial health plans to collaborate in implementing value-based payment models such as accountable care organizations (ACOs). Providers and health plans are being motivated by a growing sense that costs and budgetary constraints will inevitably require significant movement away from the fee-for-service model.

As ACOs take shape physicians need to understand the financial risks; how patients will become part of their panels; what quality measures will be used; and whether accurate, actionable, and timely data will be made available to bolster their efforts around care management and population health. The report examines the issues providers should consider before they begin the contracting conversation with commercial health plans. It also offers payor perspectives on their interest in ACO contracting as well as concerns over issues such as provider readiness and risk sharing.