ACOs: A Growing Force in U.S. Healthcare
The American healthcare landscape is evolving rapidly, with telehealth gaining momentum and staffing shortages creating fresh challenges. Amid this transformation, accountable care organizations ( ACOs) are emerging as a powerful force for change.
Experts point to ACOs as a model that prioritizes both quality care and efficient resource allocation. Christina Severin, president of Community Care Cooperative (C3), emphasized this perspective during a recent episode of the podcast "The Codcast" hosted by the Lown Institute.
Severin challenged the common belief that mergers and acquisitions are the path to affordability. "I think when you look at the data around consolidations, you just don’t find any evidence to support that thesis,” she told hosts Paul Hattis of the Lown Institute and John McDonough, a professor at the Harvard T.H. Chan School of Public Health.
She highlighted the success of federally qualified health centers (FQHCs) in delivering cost-effective, high-quality care, contrasting their performance with the outcomes often associated with large-scale mergers.
"It is a really great lesson that we don’t need to drive toward private equity, venture capital, mergers and acquisitions, privatization, and going for profit to find what is most virtuous to caregivers and providers,” Severin said. “in trying to restore the primary care environment to a place that really works for patients and really works for caregivers.”
ACOs, which often include FQHCs, allow healthcare providers to coordinate care for patients within a predetermined budget. This approach differs from the traditional "fee-for-service" model, which incentivizes more treatments regardless of their necessity.
C3 exemplifies this new approach, having grown from nine member health centers in 2018 to 23 centers across Massachusetts today. Serving almost 200,000 patients, C3 is the largest MassHealth ACO, and it also holds Medicare contracts with both the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation. These contracts simplify administrative burdens and allow C3 to leverage existing networks of specialists and hospitals, providing patients with robust access to care.
Severin illustrated how this system works in practice. Imagine a scenario where a patient requires hospitalization for behavioral health concerns. The C3 system would instantly be notified, triggering a response team. Coordinators travel to the patient’s bedside, collaborating with family and caregivers to develop the best discharge plan, recognizing that not everyone has a place to go home to.
C3 coordinators then ensure the patient’s home environment is suitable, addressing needs such as food security. They follow up via telehealth to guarantee medication adherence and confirm upcoming appointments with primary care physicians and behavioral health specialists. In some cases, C3 may identify a need for home modifications, eviction prevention, or nutritional support.
"They’re able to get the supports through partnerships with community-based organizations to assist the patient with home modification, nutrition support, groceries, medically tailored meals and tenancy preservation,” Severin explained. " which has had an incredible impact from a quality of life perspective for the patients who are served by that program.”
John McDonough, also a contributor to “The Codcast,” noted that this model represents a significant "revolution in MassHealth," yet its impact remains relatively unknown outside the realm of healthcare policy.
Looking forward, C3 plans to partner with approximately 60 health centers across eight states by 2025, ultimately serving a quarter of a million patients.
As the future of U.S. healthcare policy takes shape under a new administration, Severin remains cautiously optimistic. While expressing concern about the potential impact of President-elect Donald Trump’s nominees and their policy agendas, she acknowledges the bipartisan support historically enjoyed by health centers.
She points to Robert F. Kennedy Jr.’s, a prominent vaccine conspiracy theorist and Trump’s pick for Department of Health and Human Services secretary, proposal to alter Medicare physician payments and potentially increase funding for primary care as a glimmer of hope.
“So, you know, that’s an example of how things start up on high, but sometimes how they actually show up in the form of policy intent and re regulation change can be different,” Severin said.
With her focus on expansion and leveraging potential partnerships, Severin remains committed to the ACO model. As C3 and other similar organizations grow, they may offer a viable path toward a more accessible, efficient, and patient-centered U.S. healthcare system.
