June 5—In the emerging accountable care organization (ACO) market, upside-only shared savings payment arrangements may be the most popular, according to a white paper released today by the Premier healthcare alliance. The white paper analyzes 85 ACO arrangements. 

An upside-only shared savings structure typically involves care management programs that target high-risk and chronically ill populations. Savings that accrue are split equally between the insurer and provider with no penalties for failure to achieve agreed-upon goals. According to the white paper, these types of arrangements are attractive because they allow an organization to test care delivery models while receiving income and without fear of financial loss. 

Despite the appeal of upside-only arrangements, the Premier report indicates that commercial payers are not offering as many of these structures as their federal counterparts. The white paper points out that of those ACOs that have upside-only shared savings arrangements, nearly 60 percent fall within the Medicare Shared Savings Program or Medicare Advantage.  

The report further states that only 21 percent of commercial arrangements involve upside-only shared savings, and these agreements tended to be smaller in scope, usually for 5,000 covered lives or less. 

Publication Date: Wednesday, June 05, 2013