Models of Care Delivery and Coordination: Palliative Care Integration Within Accountable Care Organizations

Pioneer ACOs in the U.S. have been addressing the challenge of reorganizing care delivery for the sickest and most complex Medicare beneficiaries for about 5 years. Because of their assumption of financial risk, these ACOs have focused resources and expertise on the most complex and costly patients in their population- those is need of palliative care. In this chapter, we combine reports from four Pioneer ACOs- Detroit Medical Center Michigan Pioneer ACO in partnership with the Hospice of Michigan; Partners Health System Pioneer ACO; UnityPoint Health Pioneer and MSSP ACO; and OSF Health Care Pioneer ACO. The authors review their strategies for integration of palliative care principles and practices including the motivations of leadership in supporting these programs, key challenges and misconceptions encountered, utilization and clinical quality metrics used to track impact, and settings, staffing, and characteristics of care models employed.