Accountable Care Organizations

Accountable Care Organizations

The Duke-Margolis Institute for Health Policy, funded by the Gordon and Betty Moore Foundation, is investigating how accountable care approaches can improve care for people with serious illness, which is a next step in the Center’s work on accountable care. In partnership with Leavitt Partners, the project identifies promising practices and practical operational guidance that organizations could implement. Accountable Care Organizations (ACOs) offer an important strategy for improving care for serious illness populations. ACOs are by far the largest alternative payment model sponsored by Medicare, and the number of commercial ACO contracts is growing rapidly. ACOs are powerful vehicles for improving serious illness care given the incentives ACOs have to deliver effective, efficient, and coordinated care that improves outcomes and quality of life without increasing costs. Further, the ACO model offers numerous improvements in serious illness care over traditional fee-for-service reimbursement. Notably, for example, fee-for-service does not reimburse for key infrastructure and services, such as 24/7 access outside of emergency departments, patient and caregiver education, care coordination, and shared decision making, whereas the ACO model provides financial flexibility to invest in these areas and provide crucial services, and typically brings new data on patients’ healthcare use across the spectrum. While ACOs have great potential in improving serious illness care, there remains substantial opportunities for improvement due to a lack of evidence on what works, a need for practical guidance, and challenges in implementing new initiatives.

"The challenge is that we do not have a broad evidence base on what works and could serve as a best practice for accountable care in cases of serious illness across the spectrum of providers and settings."

Robert Saunders Research Director

“Providing healthcare for people with serious illnesses is incredibly complex and involves medical and social services from a variety of providers and caregivers. ACOs are a potentially powerful way to improving serious illness care in an effective, efficient, and coordinated way.”

Mark McClellan Duke-Margolis Director

Duke-Margolis Faculty & Research Team

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


Mark Japinga, MPAff

Research Associate

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

Robert Saunders

Robert Saunders, PhD

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