Implementation Sites

In an effort to begin testing and refinement of the Accountable Care Organization (ACO) model, Dartmouth and Brookings are working with health systems, physicians, commercial health insurers, and state and federal government to engage stakeholders in the challenge of addressing delivery system reform by piloting the ACO model.

Five diverse provider groups have been chosen to participate as Dartmouth-Brookings ACO Pilot Sites and are working to implement the ACO model with private payers. These sites have the resources, a conducive payer environment, a large enough patient population to support measurement, and are (real or virtually) integrated with all physicians under one organization. The pilot sites are:

• Norton Healthcare in Louisville, KY
• Carilion Clinic in Roanoke, VA
• Tucson Medical Center and affiliated physician groups in Tucson, AZ
• Monarch HealthCare based in Irvine, CA
• HealthCare Partners based in Torrance, CA

Dartmouth and Brookings are offering a high level of time and support to these five pilot sites to begin ACO implementation in collaboration with multiple payers.

The General Steps to ACO Implementation are:

1. Local providers and payers agree to pilot ACO reform
2. ACO provides list of participating providers to payers
3. Patients are “assigned” to ACOs (based on preponderance of E&M codes)
4. Actuarial projections about future spending are based on historical data
5. Determine/negotiate spending benchmark and shared savings arrangement
6. ACO implements capacity, process, and delivery system improvement strategies
7. Progress reports on cost and quality are developed for ACO beneficiaries
8. At year end, total and per capita spending are measured for all patients
9. Savings under the benchmark are shared between providers and payers