This resource describes the strategies employed by ACOs that have comprehensive care management programs for complex patients. This report is from the six-foundation collaborative and is based on responses from the National Survey of ACOs.
- Most ACOs report having comprehensive chronic care management processes or programs in place to manage people with complex needs.
- However, more labor-intensive interventions are much less common. Few ACOs report having advanced programs for engaging patients, in-home visits after hospital discharge, or evidence-based services for patients needing mental health or addiction treatment.
- While ACOs have increased their efforts to target populations with complex care needs, there are opportunities for more extensive and varied strategies.
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Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
- What strategies are accountable care organizations (ACOs) employing in providing care to patients with complex needs?
- What are the biggest opportunities for improvement?
Level of Evidence
Expert OpinionWhat does this mean?