Trade-Offs in Locational Choices for Care Coordination Resources in Accountable Care Organizations

Sian Hsiang-Te Tseui
Matthew Alcusky
Collen Florio
Michaela June Kerrissey
Peer-Reviewed Article
July 2023


Having onsite care coordinators may significantly improve the quality of patient care, while centralized coordination is associated with increased information sharing.


A strong literature base has demonstrated that care coordination is associated with improved appropriate health care utilization, patient experience, and health outcomes. Given that accountable care organizations (ACOs) often serve patients who receive services across multiple settings (primary care, specialist care, hospitals, long-term services), care coordination efforts can support bridging transitions across care settings and improve continuity of care. In this study, the researchers examine how the physical location, management structure, and colocation of care coordinators within ACOs, practice sites, or other organizations influence care quality and coordination.


The authors surveyed practice sites across all 17 Medicaid ACOs in Massachusetts and examined variation in resources and transformation efforts. Survey results demonstrated embedding care coordinators at practice sites was associated with more significant improvements in care quality, indicating that close proximity to clinical teams may enhance patient care. Centralizing care coordinators at ACO headquarters was linked to increased clinical information sharing, fostering better communication and data exchange across settings.


The presence of care coordinators in Medicaid ACOs does not guarantee effective coordination, rather location and management of care coordinators play a key role and can have significant implications for ACOs. ACOs can consider different strategies for enabling optimal organization of care coordination placement and management depending on the needs of patients, practice sites and ACOs themselves.

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