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Breaking Down Barriers to Creating Safety Net ACOs in California

A few weeks ago, UC Berkeley hosted a conference on the barriers to creating safety net Accountable Care Organizations (ACOs) in California. Stephen Shortell, Dean of the UC Berkeley School of Public Health, presented findings from his recent BSCF study that assesses safety net ACO readiness in two counties (Alameda County and Orange County) and examines legal and regulatory issues associated with forming safety net ACOs.

During preliminary interviews, researchers found that safety net providers expressed concerns about scarce capital, complicated health issues of safety net patients, and the lack of information technology and infrastructure.

A series of outreach interviews were conducted with CA safety net providers. Providers were asked 90 questions that required responses on a scale of 1-9 to assess their county’s readiness to create a safety net ACO. The 90 questions spanned 9 categories, including:

  • Organizational mission and populations served (how many adjustments would need to be made to meet the requirements and the adequacy of the health workforce to serve the target population);
  • Governance and leadership
  • Partnerships (partner willingness to adjust services to meet target population needs and readiness of partners to provide care);
  • Finance and contracts;
  • IT infrastructure;
  • Managing clinical care (cultural competency of providers, care management, behavioral health integration, and ability to deliver more cost-effective care);
  • Performance reporting;
  • Legal/regulatory issues, barriers and risk tolerance; and
  • Overall assessment.

The following graph shows a response summary of 51 respondents (26 from Alameda County and 25 from Orange County).

Section-level responses can be seen in the following chart. It is interesting to note that the large range in responses, from the lowest end of the spectrum (1) to the highest end of the spectrum (9), provide very mid-level averages.

Shortell and his team found that the major areas to work on included the shortage of providers (specifically primary care), information systems to track cost and quality, mechanisms for distributing shared savings, HER functionality, and integrating behavioral health.

Recommendations made as a result of the study can be found in this report.