PCD logo

Key Collaborative Factors When Medicaid Accountable Care Organizations Work With Primary Care Clinics to Improve Colorectal Cancer Screening: Relationships, Data, and Quality Improvement Infrastructure


This figure summarizes the 3 key collaborative factors when Accountable Care Organizations (ACOs) work with primary care clinics to increase CRC screening and the two unintended consequences. Medicaid ACOs in Oregon are called Coordinated Care Organizations (CCOs).

The left-hand side of the diagram identifies 2 factors that contribute to why a CCO would focus on CRC screening improvement. One factor is that CRC screening is a CCO quality incentive metric. The second contributing factor is that CRC screening data are obtainable and multiple interventions are known to improve CRC screening rates.

The middle part of the figure includes three boxes with text: two on top and one below. These boxes summarize the key factors that emerged in our study and highlight the sub-themes within. Arrows point between each of the boxes, indicating they all interact with one another. Clockwise from the top left, the boxes state: 1) Producing and sharing performance data (accurate reports, sharing – transparent and actionable, used to prioritize and monitor improvement); 2) Quality improvement process and infrastructure (align CCO-primary care clinic efforts, change via facilitation, learning collaboratives, and supporting clinic-based staff); and 3) Establishing relationships and partnership (history, proximity, process).

The right-hand side of the figure shows the outcomes of these efforts, which are listed as CRC interventions implemented, as well as the unintended consequences that we found in our study, which include a focus on larger clinics and potential exclusion of smaller clinics as well as metric focus and fatigue.

Three key collaborative factors when Medicaid accountable care organizations work with primary care clinics to achieve performance metrics for CRC screening. Abbreviations: CRC, colorectal cancer; CCO, coordinated care organization.

Return to Article


The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

Page last reviewed: August 15, 2019