ACOs and Network Design

Originally published by HealthCorum

Accountable Care Organizations (ACOs) are under growing pressure to improve outcomes, reduce unwarranted variation, and deliver measurable value. While many organizations have made significant strides, one area continues to challenge even the most experienced teams: effective network design.

Despite strong investments in data, provider partnerships, and care management, networks that appear comprehensive on paper do not always translate to consistent, high-value performance. The gap isn’t due to lack of effort, it’s rooted in long-standing assumptions that can unintentionally limit network effectiveness.

Below are several common pitfalls ACOs encounter and how leading organizations are addressing them.

1. Treating Network Adequacy as Network Strategy

Meeting adequacy requirements is essential, but it is only the starting point for building a high-performing network. Adequacy ensures access; strategy ensures alignment, quality, and efficiency.

High-performing ACOs take adequacy further by prioritizing high-value providers, reinforcing consistent care pathways, and supporting members with clear guidance at key decision points.

2. Underestimating the Impact of Referral Pathways

Much of the variation in cost and outcomes begins within referral decisions. Evaluating individual providers without considering their referral ecosystems can leave meaningful insights on the table.

For example, a high-quality PCP may still contribute to unnecessary spend if their referrals regularly lead to low-value care. A network strategy that includes referral mapping helps ACOs identify where alignment and support can make the biggest difference.

3. Assuming Employment Automatically Drives Alignment

Employed providers are a vital part of many ACO strategies, but employment alone doesn’t guarantee consistency or efficiency. Performance varies in every network structure, employed or affiliated.

Organizations that use data to evaluate both groups equally are better positioned to direct members to the clinicians who deliver the strongest outcomes.

4. Relying on Limited or Outdated Performance Insights

Traditional metrics and claims-based measures are helpful, but on their own, they may not provide the full picture. High-performing ACOs are increasingly incorporating:

• specialty-specific quality indicators

• cost-efficiency metrics

• episode-level variation patterns

• appropriateness of care measures

• referral behavior insights

  
  

These broader data inputs give leaders a clearer understanding of where opportunities truly exist.

5. Expecting Members to Choose High-Value Providers on Their Own

Members rarely select providers based on quality or cost alone. Convenience, familiarity, and ease of access often drive decision-making.

To support better choices, ACOs are investing in navigation tools, transparent provider comparisons, and care-management workflows that make high-value options clear and accessible.

What High-Performing ACOs Do Differently

Organizations that consistently outperform treat network design as a dynamic, data-informed process. They:

• Identify high-value providers across all specialties using comprehensive performance data.

• Map and actively manage referral pathways to promote alignment and reduce leakage.

• Equip care teams and members with transparent, easy-to-use insights that guide smarter decisions.

  
  

This approach creates networks that are more consistent, more efficient, and better aligned with value-based goals.

Where to Go From Here

As ACOs prepare for 2026, reevaluating network design is one of the most impactful steps they can take. Quality and cost vary significantly—even within the same specialty and market—creating substantial opportunities for improvement.

By leveraging modern provider performance analytics, organizations can uncover insights that traditional methods may overlook and create networks that consistently support high-value care.

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