Kentucky has three accountable care organizations, a health-reform linchpin, but they remain to be identified

The "accountable care organization" is one of the hallmarks of the federal health-care reform law, with doctors and providers encouraged to team up to give coordinated care and be paid financial incentives to do so.

While being heavily promoted, they were recently likened to "unicorns" because "no one has ever seen one." That's what William Hazel, Virginia secretary for health and human services, at the Howard L. Bost Memorial Health Policy Forum in Somerset in September.

But now a new study has emerged indicating ACOs are popping up all over the country and that there are three in Kentucky, two part of a hospital system and the other part of an independent physician association. A spokesman at Leavitt Partners, which conducted the study, would not disclose the names of the Kentucky ACOs.

To get their count, "Leavitt Partners examined news releases, media reports, trade groups and conducted interviews and considered a health system to be an ACO if it either self-identified as one or was 'adopting the tenets of accountable care,'" reports Jenny Gold with Kaiser Health News.

Of the 164 ACO entities identified nationwide, 99 were sponsored by hospital systems, 38 by physician groups and 27 by insurers. Nationwide, 41 states had ACOs, "though there were vast regional differences. Poor and rural regions were found to have little ACO growth," Gold reports. In the Southeast and Appalachian regions of the country, there are few ACOs forming.

The findings run counter to what was discussed at a recent meeting of the Friedell Committee, whose members said there are no existing ACOs in Kentucky, though they did acknowledge ACOs would have a hard time developing in rural areas: "If you know anything at all about ACOs, you know they're driving by volume," said Cris Miller, a partner in the Louisville accounting firm of Mountjoy Chilton Medley. "We're going to have a few in Louisville, probably as many as three in Lexington. Maybe have one in Bowling Green, one in Paducah. But I can promise you we will not have one in Pikeville, we will not have one in Somerset. There's not enough population."

The discrepancy might have to do with the definition of ACO. The report notes that while the term ACO has been recently adopted, its tenets are not new and organizations have been using the health care delivery model for years, just not calling it accountable care. "The study authors determined that their findings suggested a trend toward 'proclaiming oneself as an ACO with only modest changes to the care process' and not a total redesign," Gold reports. (Read more)