More than half of the US population resides within the vicinity of an Accountable Care Organization (ACO), a healthcare delivery model in which a group of providers are accountable for the cost and quality of care for a specific number of patients. However, this network of ACOs is by no means a measure of their success.

Important questions about the goals of the model and whether they will be achieved have not yet been answered. There are some signs that the ACO model is driving innovation in the industry by rewarding provider organizations for implementing high quality mechanisms for care delivery that reduce overall costs.

A New York City ACO, Montefiore, is using special scales for patients with congestive heart failure to monitor changes in weight that could cause trouble. Walgreens is using retail pharmacies as low-cost care centers to cater to its three ACOs.

However, there are inherent challenges in the adoption and implementation of the ACO model. While there have been many suggestions on how to enhance accountable care, the development of policies to standardize measurement should be the first priority. To begin with, we need to promote adoption of a core set of effective measures across payers. Current measures, such as screening for high blood pressure, are limited in scope and do not incorporate important dimensions such as meaningful health outcomes to patients and the total cost of care for those in an ACO. While there have been new proposals for advanced measures, they are yet to be adopted because of provider concerns about being held accountable for something which they do not have full control over.

However, these problems could be addressed by putting in practice the concept of “shared accountability” through patient engagement and partnerships and adopting more advanced and meaningful metrics such as functional health and total cost per capita.

Once we have such measures in place, we will need to make sure all payers are using the same metrics. As of today, each payer uses different performance benchmarks in their ACO contracts which makes it really difficult for ACOs to engage in effective self-monitoring and hold their own providers accountable as they try to strike a balance between multiple cost and quality goals.

ACOs are trying to promote a uniform payment structure using the Medicare quality metrics as the baseline, but have largely been unsuccessful because of lack of incentives and an effective standard. Additional funding is required to test value-based measures for ACO contracts which the federal government can help with.

Furthermore, collection and aggregation of under-65 claims data should be mandated or encouraged. While Medicare data is readily available for tracking the impact of ACO formation and performance, there is virtually no method to calculate the impact of the commercially insured and Medicaid populations. Less than a dozen states have all-payer claims databases and very few of them report on total cost of care.

Formation of ACOs will have different effects on care, prices and spending across markets. Without clear information on outcomes and costs, consumers will have no way to assess value and it will be impossible to evaluate ACO implementation on a regional or national level.

The Congress can offer incentives to encourage plans to provide their claims data to independent organizations in order to improve transparency – organizations which are capable of tracking, analyzing and reporting performance at various levels. The Congress can also encourage sharing of actual prices paid for services among suppliers, providers and health plans which will ensure more public reporting of meaningful information on the total cost of care.

The importance of practice and accurate measurement of ACO performance cannot be overstated. We need better measures and need to know what is happening beyond Medicare.