Weaving whole-person health throughout an accountable care framework: The Social ACO

Policymakers, health plans, and provider organizations are aggressively pursuing care delivery and payment reforms in an effort to reduce burgeoning health care cost growth and improve health outcomes. Accountable care organizations (ACOs), coupled with capitated payment arrangements, have been billed as the next great hope.

As currently structured, however, most ACOs contain a serious flaw: Although there is now significant evidence of the value of investment in certain social services interventions, the vast majority of ACO financing structures, including most of those promoted by the Centers for Medicare and Medicaid Services (CMS) and state Medicaid programs, carve out the largest drivers of health: social, environmental, and community factors. Predominantly, ACO models focus entirely on traditional health care services, even though these services only contribute to a small proportion of an individual’s health.