Accountable care organization reform: past challenges and future opportunities for public health

Objectives: This study aimed to analyze the regulatory landscape that governs accountable care organizations (ACOs) in the United States and the effects on organizational participation. Study design: This was a descriptive study of existing and prior regulations that govern ACOs in the United States. In addition, we analyze data on ACO participation over time. Methods: We used content analysis methods to the regulatory framework governing ACOs. Authors read and analyzed all regulations since 2012. Results: ACO participation has been undermined by a shifting regulatory landscape. Under the Trump administration, ACOs have had to take on additional risk earlier and that has contributed to the lowest number of participating organizations in the program's history. Conclusions: The Biden administration has the opportunity to remake regulations governing ACO development and support. (c) 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.