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Accounting for Kids in Accountable Care

Accountable care organizations (ACOs) are emerging as a cornerstone of efforts to reform the US health care system. Although naturally occurring networks of care delivery resembling ACOs have existed for years, the Affordable Care Act (ACA) formalized the ACO model as a central strategy in system redesign. The ACA calls for the establishment of pediatric ACOs after the launch of the adult focused Medicare Shared Savings Program ACOs. The Pediatric Demonstration Project is scheduled to be implemented between 2012 and 2016. It calls for state Medicaid programs to allow pediatric medical providers to form ACOs and receive incentive payments. Whereas there has been robust growth in adult-focused ACOs, the development of a pediatric ACO has yet to materialize, with little accounting for children in current accountable care models. This article explores the defining characteristics of ACOs, the evidence base for ACO implementation, and the conceptual and logistical challenges of applying a model of integrated care and reimbursement designed for adults to children.