The Difference Between Accountable Care Organizations and Accountable Care Systems

Accountable care systems and accountable care organization working seamlessly together in a codependent relationship make for excellent Accountable Care Solutions. The history of Accountable Care Organizations (ACOs) goes a little like this: a group of doctors, hospitals, and other healthcare providers come together voluntarily to give coordinated high-quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. Accountable care organizations (ACOs) are a more formal version of an ACP that may result when NHS providers agree to merge to create a single organization or when commissioners use competitive procurement to invite bids from organizations capable of taking on a contract to deliver services to a defined population.

Accountable care systems, on the other hand, are organizations in the English NHS which in some respects are intended to replicate the features of the American Accountable care organization. They are defined by NHS England as an area ‘in which commissioners and providers, in partnership with local authorities, take explicit collective responsibility for resources and population health. The basic idea behind accountable care (be it ACO or ACS) is that different organizations from the health and care system work together to improve the health of their local population by integrating services and tackling the causes of ill health. Accountable care systems(ACSs) have evolved from STPs and take the lead in planning and commissioning care for their populations and providing system leadership. They bring together NHS providers and commissioners and local authorities to work in. The new contract describes an ACS as an area ‘in which commissioners and providers, in partnership with local authorities, take explicit collective responsibility for resources and population health’.

Accountable care partnerships (ACPs) are alliances of NHS providers that work together to deliver care by agreeing to collaborate rather than compete. These providers include hospitals, community services, mental health services and GPs. Social care and independent and third sector providers may also be involved. Partnership in improving health and care in their area. In many cases, several ACPs may sit within a larger ACS area.

It marks a shift away from policies that have encouraged competition towards an approach that relies on collaboration between the different organizations delivering care such as hospitals, GPs, community services, mental health services and social care and the organizations paying for it including clinical commissioning groups (CCGs) and local authorities. This represents a different way of working in the healthcare industry – the emphasis is on places, populations and systems rather than organisations. If successful, accountable care will accelerate the implementation of new care models designed to integrate care and promote population health. It will also enable local leaders to take more control of funding and performance in their areas with much less involvement by national bodies and regulators.

According to many research findings of these three programs, ACSs and ACOs have the same objectives of integrating care and having a single approach to using resources but they are different in that ACOs are contractually integrated. ACOs were designed to improve patient experience and control federal expenditure within the US healthcare system, which is dominated by private health and insurance companies. So far the evidence of the effect of ACOs on quality is contested, and at best mixed. The projected savings to federal budgets translated into a net loss in 2015, and spending may have actually increased.