Accountable Care Organizations and Post-Acute Care: A Focus on Preferred SNF Networks

Med Care Res Rev. 2020 Aug;77(4):312-323. doi: 10.1177/1077558718781117. Epub 2018 Jul 2.


Due to high magnitude and variation in spending on post-acute care, accountable care organizations (ACOs) are focusing on transforming management of hospital discharge through relationships with preferred skilled nursing facilities (SNFs). Using a mixed-methods design, we examined survey data from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Survey data revealed that over half of ACOs had no formal relationship with SNFs; however, the majority of ACO interviewees had formed preferred SNF networks. Common elements of networks included a comprehensive focus on care transitions beginning at hospital admission, embedded ACO staff across settings, solutions to support information sharing, and jointly established care protocols. Misaligned incentives, unclear regulations, and a lack of integrated health records remained challenges, yet preferred networks are beginning to transform the ACO post-acute care landscape.

Keywords: accountable care organizations; payment reform; post-acute care; preferred networks; skilled nursing facilities; value-based payment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accountable Care Organizations / statistics & numerical data*
  • Cross-Sectional Studies
  • Humans
  • Interviews as Topic
  • Patient Discharge / statistics & numerical data*
  • Patient Transfer / statistics & numerical data*
  • Skilled Nursing Facilities / statistics & numerical data*
  • Skilled Nursing Facilities / trends
  • Subacute Care / economics*
  • Surveys and Questionnaires
  • United States