NEJM: Johns Hopkins offers advice on ACO model
In response to the Patient Protection & Affordable Care Act (PPACA), academic medical centers (AMCs) will need to address both financial and cultural barriers to the implementation of new care and payment models such as accountable care organizations (ACOs), according to a perspective article published online Feb 2. in the New England Journal of Medicine.
Scott A. Berkowitz, MD, MBA, and Edward D. Miller, MD, from Johns Hopkins University School of Medicine in Baltimore offered steps that their institution took towards accountable care that they believed would help colleagues.
“Although ACO formation may not be the best path for all AMCs, we believe that all will need to maximize quality, align incentives, and effectively use modern health IT — or risk marginalization and compromise of their clinical, research, and educational missions,” wrote Berkowitz and Miller.
According to the authors, AMCs will first have to assess the financial risk associated with pursuing ACO status. The PPACA allows for various ACO payment models based on the level of risk that the provider entity assumes, the authors stated.
“In our efforts to ensure that patients have timely access to preventive care and expedited follow-up after hospitalization, Johns Hopkins Community Physicians has expanded beyond 250 physicians, including a growing number of specialists, and Hopkins has acquired two additional regional hospital centers, expanding our service area and resources,” Miller and Berkowitz wrote. “This growth has introduced more patients into the system while creating opportunities to improve care by establishing centers of excellence and developing new integrated delivery models.”
Payment models involving higher risk intensify the financial pressure to coordinate care, the authors stated. PACE (Program of All-Inclusive Care for the Elderly at Johns Hopkins) generally collects monthly payments from Medicare and Medicaid to manage the care of patients eligible for both entitlement programs.
“By creating a highly qualified interdisciplinary care team, hiring a well-trained case manager, transporting patients to and from home, having a care assistant accompany patients to medical appointments, and creating a comfortable homelike environment at the care center, where patients enjoy meals and activities while receiving tailored care and rehabilitation, Hopkins ElderPlus, which runs PACE at Johns Hopkins, achieved operating gains of more than $100,000 in 2009 while providing care for 150 high-risk patients,” the authors offered.
Research in the science of care delivery is in its infancy, and AMCs are well positioned to spearhead efforts to develop, pilot, and disseminate new patient-focused measures and models of care, Miller and Berkowitz wrote. “They may find funding for these efforts from new sources — the Patient-Centered Outcomes Research Institute, a nonprofit entity focusing on comparative-effectiveness research that will provide annual research funding of $500 million by 2015, and the Center for Medicare and Medicaid Innovation, with its $10 billion for innovation grants and evaluating and propagating effective delivery models.”
“Ultimately, AMCs will need to determine whether becoming an ACO can be sustainable financially, how they can overcome cultural obstacles to improve care delivery, and how they can best continue to excel at fulfilling all aspects of their mission,” the authors concluded.
Scott A. Berkowitz, MD, MBA, and Edward D. Miller, MD, from Johns Hopkins University School of Medicine in Baltimore offered steps that their institution took towards accountable care that they believed would help colleagues.
“Although ACO formation may not be the best path for all AMCs, we believe that all will need to maximize quality, align incentives, and effectively use modern health IT — or risk marginalization and compromise of their clinical, research, and educational missions,” wrote Berkowitz and Miller.
According to the authors, AMCs will first have to assess the financial risk associated with pursuing ACO status. The PPACA allows for various ACO payment models based on the level of risk that the provider entity assumes, the authors stated.
“In our efforts to ensure that patients have timely access to preventive care and expedited follow-up after hospitalization, Johns Hopkins Community Physicians has expanded beyond 250 physicians, including a growing number of specialists, and Hopkins has acquired two additional regional hospital centers, expanding our service area and resources,” Miller and Berkowitz wrote. “This growth has introduced more patients into the system while creating opportunities to improve care by establishing centers of excellence and developing new integrated delivery models.”
Payment models involving higher risk intensify the financial pressure to coordinate care, the authors stated. PACE (Program of All-Inclusive Care for the Elderly at Johns Hopkins) generally collects monthly payments from Medicare and Medicaid to manage the care of patients eligible for both entitlement programs.
“By creating a highly qualified interdisciplinary care team, hiring a well-trained case manager, transporting patients to and from home, having a care assistant accompany patients to medical appointments, and creating a comfortable homelike environment at the care center, where patients enjoy meals and activities while receiving tailored care and rehabilitation, Hopkins ElderPlus, which runs PACE at Johns Hopkins, achieved operating gains of more than $100,000 in 2009 while providing care for 150 high-risk patients,” the authors offered.
Research in the science of care delivery is in its infancy, and AMCs are well positioned to spearhead efforts to develop, pilot, and disseminate new patient-focused measures and models of care, Miller and Berkowitz wrote. “They may find funding for these efforts from new sources — the Patient-Centered Outcomes Research Institute, a nonprofit entity focusing on comparative-effectiveness research that will provide annual research funding of $500 million by 2015, and the Center for Medicare and Medicaid Innovation, with its $10 billion for innovation grants and evaluating and propagating effective delivery models.”
“Ultimately, AMCs will need to determine whether becoming an ACO can be sustainable financially, how they can overcome cultural obstacles to improve care delivery, and how they can best continue to excel at fulfilling all aspects of their mission,” the authors concluded.