51. Innovative Payment and Care Delivery Models: Accountable Care Organizations in the USA

The US healthcare system has a history of continuous organizational change. The result is by no means a perfect healthcare system. However, a by-product of this history is a large number of experiments, making the USA probably the largest laboratory for healthcare delivery reform in the world. Both quality and costs are pressing issues for US healthcare reform. Efforts to address these issues by means of integrated care delivery and innovative payment models are mostly driven by the Centers for Medicare and Medicaid Services (CMS) and specifically the Center for Medicare and Medicaid Innovation (CMMI). Many of CMS’s reform efforts can be linked to goals now known as the Quadruple Aim: improving the experience of care and the health of populations, providers attaining joy in work, while reducing per-capita costs. These aims conflict with traditional, fragmented delivery structures and fee-for-service (FFS) payments, which are still the underlying structures or circumstances for reimbursing providers and delivering care for patients. One of the most discussed alternative payment models is the accountable care organization (ACO). This chapter illustrates the concept of ACOs and discusses some preliminary findings on the impact of this mode of integrated care delivery.