Study explores key pathways for establishing successful accountable care organizations

Strong leadership, reliable health care coordination and first-rate information technology are key for academic medical centers seeking to establish successful accountable care organizations, according to a Johns Hopkins study published in the journal Academic Medicine this week.

Led by Scott Berkowitz, medical director for accountable care for Johns Hopkins Medicine and assistant professor at the Johns Hopkins University School of Medicine, the study looked at the nation's first 253 Medicare accountable care organizations (ACOs), paying particular attention to the 20 percent established at academic medical centers (AMCs).

Established with the Affordable Care Act, ACOs include provider groups that are accountable for the quality, cost and overall care for a population of patients. Medicare ACOs that meet certain quality and cost-savings targets are eligible for shared savings, with some early ACOs generating savings that totaled as much as $88 million. AMCs, comprised of teaching hospitals and medical schools, can be good ACO candidates as long as leaders pay close attention to quality and cost-control opportunities, as well as risks associated with caring for large numbers of patients.

Berkowitz and co-author Jennifer Pahira write that, while the first wave of ACOs are generating data, there isn't yet a roadmap for AMC/ACO success. Using lessons learned from the nation's first ACOs, Berkowitz and Pahira identify the key areas that academic institutions must address when establishing new ACOs.

The authors found that, when establishing an ACO, AMCs first need strong leadership and a commitment to invest in organizational structures and governance to support ACO success. Berkowitz and Pahira say leadership needs to involve both primary care and specialty providers in planning and operations.

"It's important for academic medical centers to use their resources wisely when making the transition," Berkowitz says. "Effective ACOs use strategies that align quality and costs from the start."

Information technology, according to the study, can also spell success or failure for new ACOs. "There has to be an electronic medical record system robust enough to analyze and assess quality and safety issues," Berkowitz says. "It's important to quickly identify areas where changes are needed."

The coordination of care across care teams, from inpatient to outpatient, is a third success factor, according to the study. Such coordination, says Berkowitz, requires thorough communications with patients and their families, as well as partnerships with local communities.