What attribution approach is used by Accountable Care Organizations to assign accountability for cost and quality before the performance period begins?

• A. ACOs use prospective attribution to assign accountability for cost and quality before the period begins.
• B. ACOs use retrospective attribution only.
• C. Attribution is random for ACOs.
• D. Attribution is based on geographic region alone.

Answer: (A)

Prospective attribution assigns accountability for cost and quality before the performance period starts. This upfront assignment lets the ACO know which patients it is responsible for, so it can plan care management, allocate resources, and set targets for the upcoming year. It also makes performance measurement straightforward, since the population at risk is known from the outset. Retrospective attribution, which assigns patients after the period based on where care was actually received, doesn’t support proactive planning. Geographic-only or random attribution doesn’t reflect how ACOs define accountability for a defined patient population.