Top Reasons Why ACOs Lose Patients to Other Networks

Patient retention inside an Accountable Care Organization is not only a clinical issue. It is an operational one. Even when quality programs are strong and physicians are highly capable, patients may drift to other networks because access feels slow, communication is inconsistent, or administrative processes create friction. 

Complex ACO structures that span multiple practices and care settings, small breakdowns in scheduling, follow-up, and front-end revenue cycle workflows can quietly erode retention over time.

Understanding why patients leave is critical. Patient leakage impacts attribution stability, quality performance, and total cost of care management. Most importantly, it disrupts coordinated care. 

Below, we list the most common operational reasons ACOs lose patients to other networks and where leadership teams should focus attention.

1. Long Wait Times for Appointments

When patients cannot secure timely appointments, they do not wait. They look for alternatives.

This is especially true for:

• New patient visits
• Follow-up after emergency department visits
• Specialty referrals
• Diagnostic testing

If appointment availability is inconsistent or limited, patients often default to urgent care centers, retail clinics, or competing hospital systems. Over time, this creates care fragmentation and weakens attribution stability.

Operational drivers of this issue usually include:

• Rigid scheduling process
• No protected capacity for high-priority visits
• Poor demand forecasting
• Uneven distribution of provider schedules
  

2. Ineffective Scheduling

Patients expect convenience. When booking an appointment requires long phone wait times, multiple transfers, unclear instructions, or repeated calls, frustration builds quickly.

Common friction points include:

• Limited scheduling hours
• No self-scheduling options
• Inconsistent communication about required documentation
• Referral authorization confusion
  

When scheduling feels difficult, patients assume care will be difficult as well. A complex access experience increases abandonment and pushes patients toward networks that feel easier to navigate.

3. Weak Follow-Up After Acute Care

The period after a hospital discharge or emergency visit is one of the most vulnerable points in the care journey. If follow-up is not scheduled quickly and clearly, patients may seek care elsewhere.

Breakdowns typically include:

• No proactive outreach
• Delays in scheduling transition visits
• No confirmation that the patient plans to attend
• Lack of clear post-visit instructions

Without a structured follow-up workflow, patients drift. Strong transition scheduling is one of the most effective retention tools available to ACOs.

4. Referral Leakage

Specialty referrals are a major source of network loss.

Patients may leave the network when:

• In-network specialists have extended wait times
• Referral instructions are unclear
• There is no assistance scheduling
• Referral completion is not tracked

When patients are told to arrange specialty appointments on their own, many default to providers outside the network. Over time, this erodes coordinated care and affects both quality metrics and cost management.

5. Insurance and Eligibility Issues

Front-end revenue cycle problems frequently drive patient dissatisfaction.

If patients experience:

• Eligibility denials on arrival
• Authorization delays
• Confusing benefit explanations
• Unexpected financial responsibility

Trust declines quickly. Administrative surprises often cause patients to question whether they should continue care within the network.

Accurate insurance verification, clear benefit communication, and proactive authorization management strengthen patient confidence and reduce attrition.

6. Inconsistent Communication

Patients disengage when communication feels unreliable:

• No reminder messages
• Missed confirmation calls
• Inconsistent messaging across departments
• No follow-up after missed visits

Large ACO structures can create communication gaps between practices, hospitals, and centralized teams. Without standardized outreach processes, patients fall through the cracks.

7. Limited Access Channels

Patients expect flexibility and if scheduling is only available by phone during limited hours, accessibility suffers.

Patients are more likely to remain within a network when they can:

• Schedule easily
• Receive reminders digitally
• Confirm or reschedule without friction
• Access telehealth when appropriate

Improving patient access does not require clinical redesign. It requires operational modernization.

8. Lack of Centralized Operations

Large ACO networks often operate across multiple independent practices. With centralized scheduling and visibility into access and retention metrics, leakage can actually be seen as opposed to developing quietly, as it usually does. 

Common blind spots include:

• Wide variation in no-show rates by site
• Uneven time-to-appointment metrics
• Referral completion not tracked
• Follow-up scheduling inconsistently applied

Centralized monitoring of key access indicators allows leaders to identify retention risks early and correct them.

10. Administrative Friction

Small operational inefficiencies multiply in large populations:

• Incorrect contact information
• Delayed call backs
• Repeated paperwork requests
• Confusing instructions

Each friction point may appear minor on its own. At scale, they create an experience that drives patients toward networks that feel simpler and more responsive.

Impact of Patient Leakage for ACOs

When patients leave the network, the impact extends far beyond a single visit.

Leakage affects:

• Quality measure completion
• Care coordination continuity
• Attribution stability
• Shared savings potential
• Total cost of care management

Retention is directly connected to performance sustainability in value-based models.

Operational reliability at the front end plays a central role in whether patients stay engaged within coordinated care pathways.

If you are exploring ways to strengthen patient access operations and reduce leakage, discover how CCD Health supports ACOs to build scalable and performance-driven scheduling and front-end RCM workflows.