The paper analyzes how safety-net hospitals are responding to the “ACO conundrum” of accountable care efforts aiming to decrease historical hospital revenue through reduced hospital utilization. The paper explores three key strategies that safety-net hospitals serving Medicaid and uninsured populations are considering to address this conundrum: 1) increasing revenue; 2) reducing operating costs; and 3) fundamentally redefining the organization to become an ACO. Focusing on hospitals pursuing the third strategy, the paper also explores the question: What challenges does ACO development pose to safety-net hospitals, and how do they respond to these challenges? John Snow, Inc, 2015.
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