Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variation in their performance. Using data from national surveys of 399 ACOs, the researchers examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid). The researchers found that commercial ACOs were significantly larger and more integrated with hospitals, and had lower benchmark expenditures and higher quality scores compared to noncommercial ACOs. Among all of the ACOs, there was low uptake of quality and efficiency activities. However, commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods than did noncommercial ACOs. The study findings demonstrate that ACO delivery systems remain at a nascent stage, and that structural differences between commercial and noncommercial ACOs are important factors to consider as public policy efforts continue to evolve.
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