ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities

Journal Article

ACO Serious Illness Care: Survey And Case Studies Depict Current Challenges And Future Opportunities

Care for people living with serious illness is suboptimal for many reasons, including underpayment for key services (such as care coordination and social supports) in fee-for-service reimbursement. Accountable care organizations (ACOs) have potential to improve serious illness care because of their widespread dissemination, strong financial incentives for care coordination in downside-risk models, and flexibility in shared savings spending. Through a national survey we found that 94 percent of ACOs at least partially identify their seriously ill beneficiaries, yet only 8–21 percent have widely implemented serious illness initiatives such as advance care planning or home-based palliative care. We selected six diverse ACOs with successful programs for case studies and interviewed fifty-three leaders and front-line personnel. Cross-cutting themes include the need for up-front investment beyond shared savings to build serious illness infrastructure and workforce; supporting the business case for organizational buy-in; how ACO contract specifications affect savings for serious illness populations; and using data and health information technology to manage populations. We discuss the implications of the recent Medicare ACO regulatory overhaul and other policies related to serious illness quality measures, risk adjustment, attribution methods, supporting rural ACOs, and enhancing timely data access.

Duke-Margolis Authors

William K. Bleser - Margolis headhot

William K. Bleser, PhD, MSPH

Research Director, Health Care Transformation for Social Needs and Health Equity
Senior Team Member
Anti-Racism and Equity Committee Member

Robert Saunders

Robert Saunders, PhD

Senior Research Director, Health Care Transformation
Adjunct Associate Professor
Executive Team Member
Margolis Core Faculty


Mark Japinga, MPAff

Research Associate


Brystana Kaufman, MSPH, PhD

Assistant Professor, Population Health Sciences
Margolis Core Faculty

Mark McClellan

Mark McClellan, MD, PhD

Director of the Duke-Margolis Institute for Health Policy
Robert J. Margolis, MD, Professor of Business, Medicine and Policy
Margolis Executive Core Faculty