Medicare Accountable Care Organizations (ACOs) represent the nation’s largest initiative of Medicare alternative payment models toward value and health outcomes. The Centers for Medicare & Medicaid Services (CMS) have tested various ACO models with differential risk structures, and have issued a final rule to accelerate the ACOs to assume greater financial risks. In response, this research investigates whether superiority exists among various ACO models and determines their potential cost reductions. The results indicate that in minimizing health expenditures given quality services, or maximizing quality services given health expenditures, one-sided ACOs are more efficient than two-sided ACOs, so it might not be advisable to mandate the transition of ACOs from one-sided to two-sided. This research also shows that Medicare ACOs should be able to reduce expenditures significantly through efficiency improvement, without switching to two-sided tracks. Another finding is that the benchmark expenditures for a significant number of Medicare ACOs are below the efficient expenditures and should be adjusted upward.

Medicare责任医疗组织（ACO）代表了美国最大的针对价值和健康结果的Medicare替代支付模式计划。医疗保险和医疗补助服务中心（CMS）测试了具有不同风险结构的各种ACO模型，并发布了最终规则以加快ACO承担更大的财务风险。作为回应，本研究调查了各种ACO模型之间是否存在优势，并确定了其潜在的成本降低。结果表明，在最小化给定优质服务的卫生支出或最大化给定健康支出的优质服务方面，单面ACO比双面ACO效率更高，因此建议不要将ACO从单面ACO过渡到单面ACO双面。这项研究还表明，Medicare ACO应该能够通过提高效率来显着减少支出，而无需切换到双向跟踪。另一个发现是，许多Medicare ACO的基准支出低于有效支出，应向上调整。