Critical issues in alliances between management partners and accountable care organizations.

BACKGROUND: Despite widespread engagement of accountable care organizations (ACOs) with management partners, little empirical evidence on these alliances exists to inform policymakers or payers. Management partners may be providing a valuable service in facilitating the transition to population health management. Alternately, in some cases, partners may be receiving high fees relative to the value of services provided. PURPOSE: The aim of this study was to use qualitative data to identify motivations for and critical issues in alliances between ACOs and management partners. METHODOLOGY/APPROACH: We used qualitative data collected from seven ACOs (193 semistructured interviews and observational data from 12 site visits) to characterize the alliances between management partners and providers in ACOs. RESULTS: We found that ACOs sought partners to provide financing, technical expertise, and risk bearing. Tensions in partnerships arose around resources (e.g., delivery on promised resources), control (e.g., who holds decision making authority), and values (e.g., commitment to safety net mission). Some partnerships persisted, whereas others dissolved. We found that there are two different underlying models of ACO-management partner alliances in our sample: (1) short-term partnerships aimed at organizational learning and (2) long-term partnerships based on complementarity. CONCLUSION: Our results demonstrate how ACO alliances with management partners have unfolded as a kind of natural experiment in value-based payment reform. We expect that there is wide variation in quality, expertise, and delivery by management partners. Now multiple years into many of these alliances, we may address their value, strengths, and weaknesses from the perspective of providers as well as policy makers and payers. PRACTICE IMPLICATIONS: Accountable care organization providers must determine whether a management partner is the best solution to the challenges they face and, if so, which alliance model to pursue. Policymakers and payers should consider short- and long-term implications of ACO-management partner alliances, including considering changing the regulatory environment.