Based on interviews with clinical and administrative leaders, this report describes the experiences of seven accountable care organizations (ACOs). Despite gaps in readiness and infrastructure, most of the ACOs are moving ahead with risk-based contracts, under which the ACO shares in savings achieved; a few are beginning to accept "downside risk" as well. Recruiting physicians and changing health care delivery are critical to the success of ACOs--and represent the most difficult challenges. ACO leaders are relying on physicians to design clinical standards, quality measures, and financial incentives, while also promoting team-based care and offering care management and quality improvement tools to help providers identify and manage high-risk patients. The most advanced ACOs are seeing reductions or slower growth in health care costs and have anecdotal evidence of care improvements. Some of the ACOs studied have begun or are planning to share savings with providers if quality benchmarks are met.
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