Accountable Care Organisations

Accountable Care Organisations have been introduced in many settings in the USA. Evaluations are few and far between, but a recent overview [1] finds that while they do not save money, they are associated with improved processes of care (e.g. increased rates of cancer screening), and intermediate outcomes (e.g. HbA1c and blood pressure in people with diabetes). Attempts to create something similar in the UK by merging hospital and primary care budgets are underway in England, notably in Manchester. Before and after studies, such as those typically used in evaluations, are prone to exaggerate effectiveness of quality improvement initiatives,[2] thanks to the rising tide phenomenon.[3] Moreover, merging budgets is not the only way to improve coordination of care across providers, as discussed in a previous post.[4] That said, merged budgets do align provider financial incentives with patient need and core professional values, and we have not reached the end of history on this topic – not nearly.

— Richard Lilford, CLAHRC WM Director


  1. Song Z, Fisher ES. The ACO Experiment in Infancy – Looking Back and Looking Forward. JAMA. 2016; 316(7): 705-6.
  2. Eccles M, Grimshaw J, Campbell M, Ramsay C. Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care. 2003; 12: 47-52.
  3. Chen YF, Hemming K, Stevens AJ, Lilford RJ. Secular trends and evaluation of complex interventions: the rising tide phenomenon. BMJ Qual Saf. 2015. [ePub].
  4. Lilford RJ. Polycentric Organisations. NIHR CLAHRC West Midlands. 25 July 2014.

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