Benchmarking ACO Network Utilization: Lessons Learned in Network Design and Performance

For organizations across the healthcare sector concerned with network building and management, utilization of the network among the attributed population is often a major area of focus. Whether from a provider or payer perspective, maintaining a high-performing network with high utilization allows organizations to more effectively manage the quality and cost of patient care.

For Accountable Care Organizations (ACOs), maintaining high rates of in-network utilization is a particularly difficult task. By definition, Medicare fee-for-service beneficiaries can seek care wherever they please; additionally, they may not even be aware of the fact that they are part of an ACO. At the same time, ACOs are tasked with, and held responsible for, managing all aspects of their patients’ care. The more these patients go “out of network”, the less ability the ACO has to coordinate care.

Observing the amount of spend going in and out of network for ACOs in the Medicare Shared Savings Program can provide insight and a benchmark for all types of organizations concerned with optimal network design and management.

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