AS THE health care industry transforms in the age of telehealth and rattles under staffing strains, experts point to the accountable care organization model as a growing and essential piece of the puzzle.

“I think that there’s a lot of mythology around scale, and that mergers and acquisitions and consolidation is some way to be on a path toward the promised land of cost effectiveness,” said Christina Severin, president of Community Care Cooperative, on an episode of The Codcast hosted by Paul Hattis of the Lown Institute and John McDonough, a professor at the Harvard T.H. Chan School of Public Health. “And I think that when you look at the data around consolidations,” Severin said, “you just don’t find any evidence to support that thesis.”

Federally qualified health centers, by contrast, are more cost-effective and are more effective at delivering quality care, she said. 

“It is a really great lesson that we don’t need to drive toward private equity, and venture capital, and mergers and acquisitions, and privatizing, and going for profit to find what is more most virtuous to caregivers and providers,” Severin said, “in trying to restore the primary care environment to a place that really works for patients and really works for caregivers.”

Accountable care organizations, or ACOs, are federally qualified health centers that come together to provide care to patients and manage health care within a budget, rather than focusing on traditional fee for service medicine. Community Care Cooperative, a nonprofit health center-led accountable care organization also known as C3, started when Massachusetts launched an ACO program in 2018. 

C3 began with nine health centers in its organization, which has swelled to 23 centers in Massachusetts over the past eight years. The group is the largest MassHealth ACO, serving almost 200,000 patients, plus it includes Medicare contracts with the federal Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation.

Having these contracts, Severin said, “allows us to not only decrease administrative burden by not having to contract a network of specialists, hospitals, home care pharmacies,” but rather “harness the network” of MassHealth and Medicare providers to give patients access to a robust system of hospitals and specialists.

As an example of the system in action, Severin described a hypothetical patient that ends up needing hospitalization for a behavioral health condition. The C3 systems would be notified and a coordinator would travel to the patient’s bedside and work with family and caregivers to determine what the best discharge plan would be, since “not everybody has a place to go home to.”

C3 coordinators would also be able to make sure that the home a patient ends up in has food available. They could then follow up via telehealth to make sure that the correct medication is in the home and follow-up appointments are on the books with a primary care physician and behavioral health specialist. Coordinators may notice that the home needs some modification or there may be a risk of eviction.

“They’re able to get the supports through partnerships with community-based organizations to assist the patient with home modification, nutrition support, groceries, medically tailored meals and tenancy preservation,” Severin said, “which has had an incredible impact from a quality of life perspective for the patients who are served by that program.”

This program stemmed from a 2017 “revolution” in MassHealth, McDonough said. “It’s noteworthy to me that hardly anybody outside of MassHealth, and probably a lot of people in MassHealth, have no idea what this experiment is all about,” he said. “It gets so little attention and yet it’s so fundamentally important.”

As 2025 gets underway, Severin said, C3 will be partnering with about 60 health centers in eight states, serving about a quarter of a million patients. Seven of those state partnerships are already ongoing.

The national health care picture is still somewhat blurry, with both the confirmation of President-elect Donald Trump’s nominees and their policy priorities in nascent stages.

“We are being prepared and I’m also taking a wait and see approach because we really don’t know how policy intent turns into policy action, and how policy action actually shows up in regulatory change or not,” Severin said. “I tend to sprinkle a lot of optimism into my work. It just seems to work for me and that’s how I like to move forward.”

Severin noted that Robert F. Kennedy Jr. – a prominent vaccine conspiracy theorist and Trump’s pick for Department of Health and Human Services secretary – floated the idea of changing how Medicare pays physicians and possibly directing more funding toward primary care. 

“So, you know, that’s an example of how things start up on high, but sometimes how they actually show up in the form of policy intent and re regulation change can be different,” Severin said. “So I will continue to hope for the best. Health centers have always been in a position, because of who they are and what they do, that they have enjoyed nice bipartisan support.”

For more with Christina Severin – on expansion plans, potential contracts under the next administration, and investing in primary care – listen to The Codcast on Apple Podcasts, Spotify, or wherever you listen to podcasts.