The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles

Health Aff (Millwood). 2012 Aug;31(8):1777-85. doi: 10.1377/hlthaff.2012.0490.


Accountable care organizations (ACOs) are a promising payment model aimed at reducing costs while also improving the quality of care. However, there is a risk that vulnerable populations may not be fully incorporated into this new model. We define two distinct vulnerable populations, clinically at-risk and socially disadvantaged, and we discuss how ACOs may benefit each group. We provide a framework to use in considering challenges for both vulnerable patients and health systems on the path to accountable care. We identify policies that can help overcome these obstacles: strategies that support ACO formation in diverse settings and that monitor, measure, and reward the performance of providers that reach all patients, including vulnerable populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accountable Care Organizations* / economics
  • Accountable Care Organizations* / organization & administration
  • Chronic Disease / therapy
  • Health Policy
  • Health Services Accessibility / standards
  • Humans
  • Models, Organizational
  • Organizational Policy
  • Poverty Areas
  • Quality of Health Care
  • Reimbursement, Incentive
  • Social Marginalization
  • United States
  • Vulnerable Populations*