We’re glad you asked. Commercial ACO agreements have outpaced Medicare ACOs since late 2013. As readers of THE OC REPORT have noticed, about every other week one of the Big 4 signs a new agreement. Maintaining our commercial ACO database is a thankless task. 

Commercial insurers picked up on the term “accountable care” as early as 2007. Blue Cross Blue Shield launched its Alternative Quality Contract (AQC) in 2008, an ACO-like agreement that rewards doctors for better quality and lower costs. A Harvard Medical School study published in the New England Journal of Medicine in 2014 showed promising results from the AQC. (To be clear, BCBS does not call its AQC an ACO.)

Cigna was experimenting with ACOs in 2010, and Aetna, UnitedHealthcare and Health Net soon followed.  But it wasn’t until employers started using the term ACO—and large physician practices began engaging beyond Medicare ACOs—that insurers accelerated their activity in 2013. The pace hasn’t stopped since.

Today, there are 1,153 commercial ACO agreements in place. UnitedHealthcare has 520 ACOs through its Accountable Care Solutions initiative and other performance-based contracts. The company says it plans on launching 250 ACOs this year. By our count, they’re behind, but they are big enough to make it happen. BCBS has 450 ACOs, but the data aren’t clear if that includes other performance-based contracts. Cigna has 123 Collaborative Accountable Care Agreements and Aetna has 60.

Humana claims to have more than 900 ACOs but we have been unable to verify that number through independent research.

Below is a table summarizing key facts about the four largest insurers and how they have grown the concept with employers, health systems and physician groups. Thanks to Mark McClellan of the Brookings Institute—we got the idea to simplify the information in a table when we saw his presentation at a recent ACO conference. Many more details were added; the research (and any mistakes) is ours.


Dignity ACO

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