Accountable care organisations: Reflections on healthcare and public health

Abstract

The UK and USA are developing new approaches to services provision and placing emphasis on preventive actions in their populations. As part of the 2010 US Affordable Care Act, accountable care organisations (ACOs) take responsibility for defined outcomes to a population and account for patient costs and quality. Few are fully sharing financial risk with government; and successful ACOs know their high-risk populations offset the hospital admissions into lower cost settings. Few ACOs have plans for the comprehensive coverage of populations whose registration or need extend beyond the ACO boundaries. Some reach out to groups demonstrating inequalities and particular success has been shown where a provider commits to community health and adopts a whole population health strategy. Of the 50 new ‘vanguard’ models of care in the English NHS, 42 are seeking forms of integrated care with a geography, particularly between commissioners and providers. Commissioners take a more socio-ecological approach to prevention than a total emphasis on personal behaviour. In the presence of health inequalities, this is likely to yield better outcomes. New relationships, leadership, smart governance and learning between organisations trialling new models must be brought together to bring optimal future benefit to patients and wider populations.