Physicians Define 21 Principles for Accountable Care Organizations

Wednesday, October 20th, 2010
This post was written by Patricia Donovan

Four physician groups have defined 21 principles to consider when building the administrative and payment structures of accountable care organizations (ACOs). The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA) &#151, which represent a total of about 350,000 physicians, released their recommendations in a recent press release.

The principles developed by the four groups reflect attributes they believe essential for the effective implementation of the ACO model within the healthcare system. The principles state that primary care should be the foundation of any ACO and that the recognized patient and/or family-centered medical home is the model that all ACOs should adopt for building their primary care base.

The new joint principles include:

Structure of the ACO

  • They provide accessible, effective, team-based integrated care based on the Joint Principles of the Patient Centered Medical Home for the defined population they serve.

  • They demonstrate strong leadership among physicians and other healthcare professionals.

  • Organizational relationships and all relevant clinical, legal, and administrative processes within ACOs are clearly defined and transparent.

  • They include processes for patient and/or family panel input in relevant policy development and decision- making.

  • They include a commitment to improving the health of the population served through programs and services that address needs identified by the community.

  • They provide incentives for patient and/or family engagement in their health and wellness.

  • Participation by physicians, other healthcare professionals, and patients/families is voluntary.

  • Nationally accepted, reliable and validated clinical measures are used to measure performance and efficiency and evaluate patient experience.

  • They implement clinically integrated information systems to provide relevant information at the point of care and assist in care coordination.

  • Barriers to small practice participation are addressed and eliminated.

  • They are adequately protected from existing antitrust, gain-sharing and similar laws that currently restrict the ability of providers to coordinate care and collaborate on payment models.

  • They promote processes to reduce administrative complexities.


  • The payment models and incentives implemented align mutual accountability at all levels.

  • The payment models and incentives implemented adequately reflect the relative contributions of participating physicians and other healthcare professionals.

  • The payment models used recognize effort required to involve family, community/educational resources and other pertinent entities and activities related to care management/care coordination of patients with complex conditions.

  • Recognition and rewards for the ACO’s performance are based on processes that combine achievement relative to set target levels of performance.

  • Practices participating within ACOs that achieve recognition as medical homes by NCQA or other nationally accepted certification entities should receive additional financial incentives.

  • The structure adequately protects ACO physicians and other healthcare professional participants from “insurance risk.”

  • They employ a variety of payment approaches to align the incentives for improving quality and enhancing efficiency while reducing overall costs.
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