Accountable care organizations need to target specific patient populations, and policymakers should periodically re-evaluate the promise of the ACO model to help avoid the failures of earlier integrated delivery networks, according to a new opinion piece published in the journal Health Affairs.

In their analysis, Lawton Burns, chairman of the healthcare management department at the University of Pennsylvania's Wharton School, and Wharton professor Mark Pauly note that healthcare providers in the 1990s developed networks—such as the Piedmont Health Alliance and Spectra Health System—that connected hospitals, physicians and alternate care sites in a way that is similar to how ACOs are designed today. But those arrangements failed, the authors argue, because they "lacked a large, salaried, multispecialty group of physicians, an insurance vehicle and experience in managing risk-based contracts." In the end, those networks were ultimately unsuccessful in both improving quality and lowering healthcare costs.

To avoid following this path, ACOs should focus on specific populations, such as patients with chronic conditions, the authors conclude. In addition, policymakers should revisit what ACOs have promised, as the authors suggest these models might not be a "silver bullet," but rather a "bronze buckshot" that could be a part of a wider range of efforts to achieve the so-called Triple Aim of improving the experience of care, improving healthcare for patient populations, and lowering healthcare costs.

Meanwhile, the issue also includes an article that examines the results of four provider organizations (PDF) participating in the Brookings-Dartmouth Accountable Care Organization Collaborative; and another that concludes the Robert Wood Johnson Medical School has faced "conceptual, financial, cultural, regulatory, organizational and historical" challenges in its effort to establish an ACO.