Shared Savings Models for ACOs-Incentivizing Primary Care Physicians

Abstract

Increasing numbers of health systems and physician practices are considering formation of accountable care organizations (ACOs) to promote clinical integration and to create a potential revenue stream through shared savings. In large part, the ACO triple aim of improved experience of care, better population health and decreased cost is to be achieved by empowering primary care physicians who will be the “quarterbacks” for preventive care and care coordination and will serve as the main source of attribution for patients to an ACO. As competing ACOs are established within overlapping markets, an ACO’s success will be determined in large part by its ability to attract and retain a vibrant and effective primary care workforce, currently experiencing a national shortage. Although the potential for financial incentives through shared savings is one way in which ACOs can attract primary care providers, there is currently no agreed upon taxonomy for categorizing or evaluating shared savings distribution methodologies and their impact on primary care providers and organizational success. Herein we propose a taxonomy of shared savings decision-making and discuss four models for shared savings distribution that recognize the increasing importance of primary care within ACOs.