A Taxonomy of Accountable Care Organizations: Different Approaches to Achieve the Triple Aim

As providers begin to bear risk for defined populations, providers and payers have begun to change the way they deliver and pay for health care. Accountable care organizations (ACOs), in particular, have proliferated with the common goal to fulfill the triple aim of improved patient satisfaction, improved care and decreased health care costs. Though ACOs operate with similar objectives, they vary considerably in their organizational structure, ownership and patient care focus. By incorporating information from ACO surveys, ACO director interviews and a comprehensive database of American ACOs, we identify six core types of structurally distinct ACOs. For each ACO type, we identify commonalities, principal challenges and different opportunities to achieve the triple aim. This ACO taxonomy will help researchers evaluate ACOs, serve as a resource for policymakers to revise ACO programs and provide direction to vendors to create services and products that will facilitate the transition to value-based care.