A new report issued by the Commonwealth Fund (CWF) finds that, contrary to previous assumptions, dominant market share, employed physicians and financial strength are not essential requirements for a health system to successfully implement an accountable care organization (ACO).

The findings are based on an in-depth analysis of 59 health systems of various sizes, characteristics and regional locations, along with in-person site visits. The organizations are part of Premier's Partnership for Care Transformation (PACT) Readiness Collaborative, launched in June 2010 to help organizations transition to accountable care.

"Although much has been written about the potential merits of ACOs, little information exists to help providers understand the capabilities needed to create and participate in an effective model that can constrain healthcare costs while improving quality," said Eugene Kroch, lead author of the report and Premier vice president and chief scientist.

To address the lack of data evaluating the readiness of providers to implement ACOs, Premier developed a "capabilities framework" tool to assess health system progress toward meeting the requirements of an ACO model. According to Kroch, Premier's framework includes the need for: a patient-centered foundation; a primary care medical home; a set of providers that deliver quality care at an efficient price; payer partnership; population health data management; and governance.

Premier President and CEO Susan DeVore, one of the paper's authors, said, "What the study ultimately shows is there are different paths toward successful implementation of this model."

ACOs are an idea whose time has come, but they are hard work, says Gene Lindsey, MD, president and CEO of Newton, Mass.-based Atrius Health, a nonprofit alliance of six community-based medical groups serving nearly one million patients throughout Massachusetts. Atrius Health was chosen as one of 32 organizations to participate in the Pioneer Accountable Care Organization (ACO) federal pilot, begun a year ago. Prior to participating in the Pioneer ACO model, Atrius Health had been functioning as an ACO for many years, according to Lindsey.

"Organizations have to put a lot of trust in the model to be financially sound, so that they can be rewarded; and in the capabilities of the organization to perform in an improving fashion," he says. "You don't go into an ACO mindset without expecting that change in behavior will be required. ACOs are predicated on innovation."

It takes an incredible amount of managerial capacity to run an ACO, much of which a new ACO must learn from scratch, Lindsey says.