Examining ACO Makeup Evolution During Past Three Years

By Clive Riddle, August 14, 2015

Compiling Accountable Care Directory Data, we can look at how the makeup of ACOs around the country has evolved from since 2012. MCOL’s HealthQuest Publishers just released version 2 of its 2015 Accountable Care Directory, and has published updated directory twice a year since mid 2012. We’ve compiled data from the directories to provide a look at ACO composition over time.

A few challenges present themselves in considering the data – the biggest one involving commercial ACO reporting. Given there is no uniform standard, or reporting requirement for what constitutes an commercial ACO, there is certainly a disparity as to the national number of commercial ACO arrangements that are reported by various organizations. But at least in looking at the same company’s reporting on commercial arrangements over time, there is at least a relative measure.

Another issue is that the number of Medicare ACOs will be very close, but not exactly match CMS reporting year by year, due to the timing of reporting specific contract cancellations and CMS counting multiple contracts for a few organizations.

But with that said, here’s a snapshot of Accountable Organizations, past and present:

ACOs by top 25 States:

State	Mid 2012	Jan 2013	Mid 2013	Jan 2014	Mid 2014	Jan 2015	Mid 2015
CA	23	34	42	49	51	57	54
FL	17	33	35	46	47	48	48
TX	16	22	25	38	39	41	41
NY	17	19	21	25	25	31	31
NJ	8	14	15	23	23	26	26
IL	3	7	7	11	14	22	22
MA	11	18	18	19	20	22	22
NC	6	9	9	14	17	20	20
GA	10	12	12	16	17	17	17
MD	7	9	10	14	14	18	17
VA	4	6	7	15	16	17	17
MI	5	7	7	13	13	16	16
OH	7	12	12	14	14	16	16
IN	4	7	7	10	10	15	15
TN	7	10	11	13	14	16	15
AZ	5	9	9	12	13	15	14
PA	2	5	6	10	10	15	14
CO	3	7	8	10	10	11	10
CT	2	6	6	7	7	11	10
ME	8	9	10	10	10	10	10
MO	2	5	5	8	8	10	10
KY	5	6	6	6	7	9	9
WI	5	8	8	9	9	10	9
AR	1	1	3	4	4	8	8
MN	5	6	6	8	8	8	8
Others	24	40	41	61	63	74	73
Grand Total	207	321	346	465	483	563	552

ACOs by Medicare vs, Commercial Contracts:

Type	Mid 2012	Mid 2013	Mid 2014	Mid 2015
Medicare Only	126	209	307	346
Commercial Only	59	96	118	130
Both	22	41	59	77
Grand Total	207	346	484	553

Mid 2015 ACO Attributed Patients Per ACO

Patients	Medicare	Commercial
< 10 K	28.8%	38.5%
10K - 24K	42.4%	28.6%
25K - 49K	18.8%	16.5%
50k - 99K	5.9%	9.9%
100K +	4.1%	6.6%
Avg/ACO	33,262	61,209
% Reporting #	40.2%	44.0%

The average attributed patients combined for Commercial and ACO in Mid 2015 was 32,566, compared to 29,584 in Mid 2012.

Mid 2015 ACO Physicians Per ACO

Physicians	Percent
<50	10.5%
50-99	10.8%
100-249	21.7%
250-499	20.4%
500-999	19.2%
1000+	17.3%
Avg	509
% Reporting #	58.4%

The average number of physicians per ACO historically has been:

	Mid 2012	Mid 2013	Mid 2014	Mid 2015
Physicians	620	613	567	509