Accountable Care Organizations often struggle to achieve shared savings goals, despite having effective care teams and clear objectives. It is often infrastructure and data insight limitations that challenge ACO performance.
ACO Performance depends on identifying cost trends early enough to influence care decisions before unnecessary utilization occurs. Many established systems force teams to respond to historical cost increases instead of preventing new ones.
Claims often arrive 60–90 days after services are delivered. Risk scores sometimes fail to reflect a patient’s current clinical status, which can misdirect care priorities. Attribution shifts unexpectedly. High-cost patterns hide in disconnected systems. These ACO performance barriers can slow operations, limit proactive care management, and significantly reduce shared savings potential.
Barrier 1: Claims Data Arrives 60-90 Days Late
Many ACOs receive claims data with delays that can extend several weeks to a few months. Care managers often receive patient information after meaningful intervention opportunities have passed.
The Cost of Delayed Visibility
● Care teams work with outdated patient records
● High-risk members go unidentified for months
● Cost overruns appear only after they've occurred
● Resources get allocated to closed cases
Real-time visibility would catch ER visits, medication gaps, and care avoidance as they happen. Instead, ACOs discover problems after financial damage is done.
Barrier 2: Risk Scores Don't Reflect Current Patient Status
Risk stratification models estimate future utilization and cost risk primarily using historical claims and clinical data. Patients decline or improve more quickly than models refresh, which leads care managers to focus on priorities that may no longer reflect current patient needs.
Misaligned Resource Allocation
Outdated risk scores send care managers to stable patients while high-need members slip through gaps. Teams invest time in low-risk outreach while critical cases worsen undetected. ACO Performance in 2026 requires a dynamic risk assessment that updates as patient conditions change.
Barrier 3: Attribution Changes Disrupt Care Continuity
Patients may change providers mid-year, while attribution updates typically occur quarterly. ACOs invest in care coordination programs only to lose enrolled members before seeing results.
Impact on ROI and Planning
Attribution instability causes:
● Lost care management investments when patients leave
● Impossible ROI calculations on programs
● Disrupted long-term care strategies
● Wasted resources on members who won't stay attributed
This barrier increases financial risk for care investments because ACOs cannot guarantee they will benefit from improved outcomes.
Barrier 4: Fragmented Systems Hide Critical Information
ACOs often operate across multiple disconnected platforms. Care managers toggle between EMRs, claims databases, risk tools, and scheduling systems to build complete patient pictures.
Operational Slowdown Across Teams
Each platform holds partial data. Staff spend hours reconciling information across systems. Critical details get buried in separate databases. Workflows break when tools don't communicate.
An integrated digital health platform can reduce this obstacle by consolidating data streams into a single, actionable clinical and financial view. Giving a team access to complete records in real time allows them to take relevant action before costs get out of hand.
Barrier 5: High-Cost Patterns Go Undetected Until Too Late
Without integrated visibility, ACOs often fail to identify emerging cost patterns like frequent ER use, medication non-adherence, and preventable readmissions until claims arrive months later.
Detection Failures Across Care Areas
● Pharmacy costs spike without triggering alerts
● Specialist referrals multiply unchecked
● Care gaps widen as patients skip preventive visits
● Chronic condition management deteriorates quietly
By the time patterns show up in quarterly reports, the financial impact has already hit budgets.
Barrier 6: Manual Forecasting Misses CMS Actuals by Millions
ACOs build projections using spreadsheets and historical trends. CMS calculates actuals using validated claims data and complex attribution and risk adjustment methodologies. In larger ACOs, these forecasting gaps can translate into substantial financial variance.
Why Projections Fail Consistently
Manual methods can't process the variables that CMS considers seasonality patterns, attribution changes, risk adjustments, and regional benchmarks. ACOs plan around inaccurate forecasts, then face budget crises when actual results arrive.
Barrier 7: Intervention Windows Close Before Teams Can Act
Care management works when interventions happen early. But data lags combined with fragmented systems mean ACOs identify problems after action windows close.
The Timeline Problem
A patient visits the ER multiple times in Week 1. Claims arrive in Week 8. Care managers spot the pattern in Week 10. Outreach begins in Week 12, but the patient is already hospitalized. Early intervention could have prevented hospitalization. Late intervention often results in retrospective documentation rather than prevention.
This timing failure repeats across thousands of patients, eliminating shared savings potential.
Barrier 8: Reactive Technology Prevents Proactive Management
Many legacy ACO platforms were designed primarily for reporting rather than real-time intervention. They show what already happened instead of flagging what's developing.
Some platforms provide real-time data aggregation with AI-driven cost predictions. They identify emerging trends earlier in the care cycle, before full budget impact occurs. Teams get alerts when patients show early warning signs, creating intervention opportunities that legacy systems miss.
How These Barriers Multiply Each Other
The eight barriers don't operate independently. Claims lags hide problems, while risk score misalignment misdirects resources. Attribution instability disrupts planning as fragmented systems slow response times. Manual forecasting creates budget surprises while intervention windows close. Each barrier amplifies the others.
ACO Performance Barriers work together to trap organizations in reactive cycles where teams always respond too late to prevent costs.
Final Thoughts
ACO Performance requires infrastructure that matches value-based care complexity. The eight barriers outlined here aren't isolated issues. They're interconnected challenges that significantly reduce shared savings potential. Solving them means moving from fragmented reactive systems to unified proactive platforms that provide visibility when it matters.
Persivia provides data-driven solutions built to support ACO performance across cost management, risk assessment, and care coordination. By integrating clinical and financial data, enabling earlier visibility into cost trends, and supporting predictive analysis, Persivia helps organizations identify risks sooner and act before avoidable utilization occurs. This approach allows ACOs to move beyond retrospective reporting and make decisions that protect shared savings and care outcomes.
