Building an ACO is one of the most powerful strategies health systems are adopting to improve outcomes, lower costs, and strengthen care coordination under value-based care. In 2024, nearly half of traditional Medicare beneficiaries are now aligned to an ACO, with more providers moving into risk, investing in primary care, and expanding telehealth and community-based services.
ACOs have shown measurable gains in quality, reduced inpatient and ED use, and increased preventive care in both Medicare and Medicaid populations. The value of investment (VOI) goes beyond shared savings. Leaders also gain stronger care coordination, more resilient infrastructure, and the ability to scale growth without burning out teams.
Building an ACO—turning that promise into sustained performance—is not easy. Benchmarks reset, patient profiles shift, workflows get tangled, and even strong practices may still leave money on the table. Leaders often cite struggles with clinician engagement, documentation accuracy, and alignment across finance, operations, and clinical teams.
If you’re leading or launching an ACO, you know that success requires more than vision. It takes infrastructure, consistent training, and system-wide processes. Here are five challenges every ACO faces when forming, norming, and growing—and how VBCTP helps close the gaps so your ACO not only launches but thrives.
1. Change Management & Alignment
The Opportunity: Alignment can transform a patchwork of providers into a coordinated network ready to capture savings, boost quality scores, and deliver better care consistently.
The Challenge: In practice, an ACO isn’t one clinic. It’s dozens of sites, multiple boards, and a mix of payors and partners. Without clear alignment across finance, clinical teams, and administrators, the result is duplication, confusion, and uneven performance.
How VBCTP Helps: We bring clarity out of complexity. Our change management program aligns teams around common goals with shared scorecards and repeatable playbooks. The VOI: reduced duplication, stronger engagement, and a foundation for growth.
2. Onboarding & Training at Scale
The Opportunity: Growth expands reach, impact, and shared savings, as new contracts and clinics bring more patients, more opportunities to improve outcomes, and faster scaling when onboarding is done well.
The Challenge: Rapid growth can overwhelm staff already stretched thin. Each site may create its own ad hoc training approach, leaving some providers highly prepared while others struggle. Without consistent onboarding, results vary widely, and uneven performance drags down the whole network.
How VBCTP Helps: We enable ACOs to onboard at speed without sacrificing quality. Our structured learning approach equips every provider and staff member with targeted training, while giving leaders clear visibility into readiness and support needs. The VOI is faster time-to-readiness, lower turnover, and a consistent standard of care that protects quality scores.
3. Population Health & SDOH Integration
The Opportunity: One of the greatest promises of building an ACO is the ability to manage whole populations, not just episodes of care. When clinical data is integrated with social determinants of health (SDOH), ACOs can prevent unnecessary hospitalizations, close equity gaps, and create a competitive advantage that drives shared savings.
The Challenge: Most ACOs already have strong data aggregation platforms, but too often those tools stop at reporting. They flag gaps after the fact instead of preventing them in real time. Without predictive analytics, proactive navigation, and embedded SDOH workflows, care gaps remain unaddressed, high-risk patients slip through, and costs continue to rise.
How VBCTP Helps: We help ACOs see risk before it becomes cost. Using predictive analytics and standardized population health navigation, teams can identify rising-risk patients early, embed social risk into workflows, and manage care consistently across practices. The VOI is fewer missed opportunities, reduced utilization, healthier communities, and measurable progress on equity goals.
4. Clinical Documentation & Risk Adjustment
The Opportunity: Accurate documentation and risk adjustment are central to building an ACO that thrives both financially and clinically. When every diagnosis is captured and charts reflect true patient complexity, ACOs maximize revenue, strengthen care planning, raise quality scores, and ensure audit readiness.
The Challenge: In reality, performance is uneven: some clinics excel at capturing risk while others fall behind, dragging down the ACO’s overall financial and quality results. Reports may flag gaps, but they don’t help providers in the exam room who need point-of-care support to document accurately. Without that support, performance variation persists and opportunities are lost.
How VBCTP Helps: We build the capability to capture value where it counts — at the point of care. Providers gain real-time insights that surface conditions and close gaps during visits, while consistent documentation practices are reinforced across clinics through structured training. Fractional support for coding, reviews, or audit prep gives leaders extra capacity when it’s needed most. The VOI: greater financial resilience, fewer compliance risks, and a more accurate reflection of patient complexity.
5. Bandwidth Relief During Growth Spurts
The Opportunity: Rapid expansion—scaling from thousands to hundreds of thousands of covered lives—means more patients served, more contracts under management, greater shared savings, and a stronger market position for the ACO.
The Challenge: With growth comes strain, as leaders juggle multiple payers, contracts, and scorecards while staff are already stretched thin. Onboarding new sites, managing clinic variation, and meeting reporting demands can overwhelm even high-performing teams, leading to burnout and inconsistent execution.
How VBCTP Helps: We deliver the infrastructure that makes rapid growth sustainable by assessing strengths and gaps across every clinic. Our approach highlights where reinforcement is needed, whether it’s documentation, patient navigation, engagement, or coding. With this clarity, leaders can direct resources strategically and avoid spreading support too thin. The VOI: long-term stability, consistency, and sustainable performance.
Why Modularity Matters
Not every clinic has the same needs. One site may document flawlessly but struggle with navigation. Another may shine in patient engagement but fall behind on coding. A one-size-fits-all approach risks under-serving some practices while wasting resources on others.
That’s why VBCTP’s model is modular and fractional. Practices that need stability can focus on foundational training for ROI and compliance, while stronger sites can take only the modules they need to sharpen performance or capture overlooked revenue. Leaders can also opt for fractional support — bringing us in to handle specific functions or time-limited projects without the cost or commitment of full-scale outsourcing.
The result is a system that scales up or down as needed. Every clinic gets a clear path forward, leadership can focus on strategy instead of firefighting, and the ACO as a whole grows stronger as it expands.
The Bottom Line
ACOs are proven, but sustaining success requires more than contracts. Benchmarks reset, patient populations shift, and no two clinics perform at the same level. The organizations that thrive are the ones that invest in infrastructure, training, and consistency, building a foundation that turns vision into results.
At VBCTP, we’ve built physician-led, data-driven solutions designed to help ACOs smooth out the roller coaster, capture savings year after year, and grow with confidence.
If you’re forming, building, or strengthening an ACO, let’s talk. We’ll walk through your goals, the risks on your horizon, and the practical steps to manage growth without burning out your teams. Together, we can make sure your ACO is built to last.
Whether you need comprehensive infrastructure or fractional support for a specific function, VBCTP helps your ACO grow stronger without overwhelming your teams.
