NEJM article spotlights financial risks associated with ACOs
Before embracing an accountable care organization model, academic medical centers need to assess the financial risk, according to The New England Journal of Medicine.
The authors of the Feb. 2 online article, Scott A. Berkowitz, MD, a fellow in cardiology and geriatrics at the Johns Hopkins University School of Medicine, and Edward D. Miller, MD, dean and CEO of Johns Hopkins Medicine, assert that AMCs can't remain relevant in the face of sweeping change, but can lead the way by serving as examples of successful transformation while continuing to excel in achieving their mission. For some AMCs, this may take the form of becoming accountable care organizations, as established in the Affordable Care Act.
First and foremost, they said, AMCs must have an integrated system of sufficient size and breadth to provide necessary and timely inpatient and outpatient services across the full continuum of care, including primary and specialty care. Secondly, AMCs need to assess the financial risk associated with pursuing ACO status.
The authors note that the Affordable Care Act allows for various ACO payment models based on the level of risk that the healthcare organization assumes. For example, under partially capitated models, the ACO would be at risk for the cost of some, but not all, of the services covered by Medicare.
[See also: CMS ramps up for ACOs, seeks physician input.]
Third, the authors said, AMCs need a robust health information technology platform that captures all patient-encounter information into a standardized system that permits providers to share information, enhances clinical decision-making and facilitates rapid analysis of input data.
Last, and potentially the most challenging point, involves changing the historic culture of AMCs, which traditionally favor, in terms of advancement, faculty grant support, publications and scholarly reputation over contributions to high-quality care.
[See also: Experts warn ACOs could cause market power issues.]
The authors cite several examples from Johns Hopkins Medicine that illustrate successful components of an ACO-like model, including health system network expansion, increases in primary care capability and success in managing capitated care programs.
"Despite the barriers to becoming an accountable care organization, healthcare reform brings great opportunities for academic medical centers to modernize their approaches to research, education and clinical care," Berkowitz said.
"In many important respects, academic medical centers are ideally positioned to implement meaningful healthcare reform," said Miller. "They have the requisite infrastructure, intellectual capital and networks to spearhead efforts to develop, pilot and disseminate new patient-focused measures and care models."
