Management Partnerships (‘ACO Enablers’) Are Pervasive Part of ACOs

In theory, ACOs are groups of providers that band together to lower the cost of health while maintaining its quality by using various tools in the value-based care (aka population health) toolkit: care coordination, data analytics, avoidance of low-value services.

But a study published in this month’s issue of Health Affairs possibly—it is open to several interpretations—paints a very different picture of ACOs as creatures of a relatively small group of management partner companies that are tapping into the money that can be made in setting up and running an ACO. In industry circles, these companies are known as “ACO enablers.”

The title of the piece in Health Affairs is “The Hidden Roles That Management Partners Play in Accountable Care Organizations.”

“In the scholarly literature they are just not noticed—or known about,” says Valerie A. Lewis, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice, and the lead author of the study.

The data in her study was de-identified. But ACO enablers that have been mentioned by name in the media and elsewhere include Collaborative Health Systems (which is owned by WellCare Health Plans), Evolent, and Caravan Health.

Lewis and her colleagues used data from the National Survey of Accountable Care Organizations to conduct their research. The survey, a longitudinal survey that started in 2012, is sponsored by the Dartmouth institute, University of California–Berkeley, and The Commonwealth Fund.  For this particular study, the researchers homed in on a sample of 276 ACOs and 2013–2015 survey data.

They found that 37% of the ACOs reported having a management partner and that two thirds of those ACOs shared financial risk and rewards with their partner. Services that the partners provided included data services (94%), administrative services (87%), and care coordination (66%).

ACOs with management partners were more likely to be composed of physician groups only than ACOs without partners (45% vs. 18%). Also not surprising: The partnered ACOs were also less likely to have a hospital involved (74% vs. 46%).

It’s noteworthy that Lewis and her colleagues didn’t find statistically significant differences in either the cost or quality performance of the 56 partnered ACOs among the 148 ACOs participating in Medicare ACO program.

Lewis says it will take more research to figure out whether management companies are having a positive and negative effect—and very possibly both—on value-based care and American health care overall. They may make ACOs possible by providing expertise and services that are beyond what a physician group could develop internally. But in Health Affairs, Lewis and her colleague mention that “some observers” say that the fees of the ACO enablers are high relative to the value of the services they provide. If large chunks of shared savings are going to management partnerships and never reach physicians, the financial incentives for practicing value-based care may disappear.

Physicians and others would have a better idea of what they are getting into when they joined an ACO if there were some guidances written about these partnership arrangements, transparency once they were underway, and possibly regulation, Lewis suggests.