This episode was originally released on January 4, 2022.

The Medicare program has placed considerable emphasis on creating accountable care organizations (ACOs), which are groups of health care providers that together take responsibility for providing necessary care and can reap financial rewards if they do so at lower than projected costs.

While the American Hospital Association reports that 56 percent of community hospitals participate in an ACO, ACOs have developed more slowly in rural than in urban areas.

Observing that not all health care providers can afford the infrastructure cost necessary to make an ACO work, the Center for Medicare and Medicaid Innovation developed the ACO Investment Model (AIM) which supports physicians, clinicians, and smaller hospitals in their formation of ACOs.

The AIM Program evaluation has some interesting lessons for those seeking to promote accountable care.

Matthew Trombley from Abt Associates joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss how to support ACO creation in less populated areas.

Trombley and coauthors published a paper in the January 2022 issue of Health Affairs examining outcomes following implementation of the Medicare Shared Savings Program in 41 rural ACO investment model facilities.

They found significant savings net of program costs but also rapid exits from the program once providers were exposed to downside financial risks.

If you enjoy this interview, order the January 2022 Health Affairs issue.

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