Substantial Physician Turnover and Beneficiary ‘Churn’ in a Large Medicare Pioneer ACO

Alternative payment models, like accountable care organizations (ACOs), attempt to stimulate improvements in care delivery through better alignment of payer and provider incentives. However, limited attention has been paid to the physicians who actually deliver the care. In a large Medicare Pioneer ACO, this study — published in the April 2017 issue of Health Affairs — found that the number of beneficiaries per physician was low (median of seventy beneficiaries per physician, or less than 5 percent of a typical panel). It also found substantial physician turnover: More than half of physicians either joined (41 percent) or left (18 percent) the ACO during the 2012–14 contract period studied. When physicians left the ACO, most of their attributed beneficiaries also left the ACO. Conversely, about half of the growth in the beneficiary population was because of new physicians affiliating with the ACO; the remainder joined after switching physicians.

ACO News is a feature of the Medicaid Accountable Care Organization Resource Center, an online collection of tools designed to help Medicaid agencies develop and launch accountable care organizations.