First steps for population health

Background. The Accountable Care Organization (ACO) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation. Objective. To determine the number of accountable care organizations in the United States, where they are located, and characteristics associated with ACO formation. Study Design, Methods, and Data. Cross-sectional study of all ACOs in the United States as of August 2012. We identified ACOs from multiple sources; documented service locations (practices, clinics, hospitals); and linked service locations to local areas, defined as Dartmouth Atlas hospital service areas. We used multivariate analysis to assess what characteristics were associated with local ACO presence. We examined demographic characteristics (2010 American Community Survey) and health care system characteristics (2010 Medicare fee-for-service claims data). Principal Findings. We identified 227 ACOs located in 27 percent of local areas. Fifty-five percent of the US population resides in these areas. HSA-level characteristics associated with ACO presence include higher performance on quality, higher Medi-care per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location. Conclusions. Much of the US population resides in areas where ACOs have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context. Key Words. Accountable care organizations, Medicare, health care reform, incentives in health care, health policy, delivery of health care, health care costs

2012

AriccA D. VAn citters, BriDget K. LArson, KAthLeen L. cArLuzzo, Josette n. gBemuDu, sArA A. KreinDLer, FrAnces m. Wu, stephen m. shorteLL, eugene c. neLson, AnD eLLiott s. Fisher Abstract: This report synthesizes findings and lessons from case studies of four diverse health care organizations participating in the Brookings-Dartmouth ACO Pilot Program, launched in 2009 to support selected provider groups that are collaborating with private payers to form accountable care organizations (ACOs). The organizations are: HealthCare Partners, a medical group/independent practice association (IPA) in Los Angeles, Calif.; Monarch HealthCare, an IPA in Orange County, Calif.; Norton Healthcare, an integrated delivery system in Louisville, Ky.; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, Ariz. Each has agreed to take responsibility for overall quality and costs of care for their patients, and each has a com- mitted private payer partner and...

2009

2012

Issue brief (Commonwealth Fund), 2012

Accountable care organizations (ACOs) are forming in communities across the country. In ACOs, health care providers take responsibility for a defined patient popu­lation, coordinate their care across settings, and are held jointly accountable for the quality and cost of care. This issue brief reports on results from a survey that assesses hospitals' readiness to participate in ACOs. Results show we are at the beginning of the ACO adop­tion curve. As of September 2011, only 13 percent of hospital respondents reported partici­pating in an ACO or planning to participate within a year, while 75 percent reported not considering participation at all. Survey results indicate that physician-led ACOs are the second most common governance model, far exceeding payer-led models, highlighting an encouraging paradigm shift away from acute care and toward primary care. Findings also point to significant gaps, including the infrastructure needed to take on financial risks and to manage populati...

2009

Journal of Spinal Disorders & Techniques

The passage of the Patient Protection and Affordable Care Act in March 2010 has resulted in dramatic changes to the delivery of health care in the United States toward a value-based system. While this is a significant change from the previous model, it presents an opportunity for high-quality health care providers to improve patient outcomes while also increasing revenue. However, those that lack a clear strategy to effectively implement change and communicate the increased value to the patients likely will suffer, regardless of how successful or prestigious they seem today.

Journal of Healthcare Management, 2018

2009

Nurse Leader, 2016

2017

• Understanding Population health -what is it and how do we achieve it? • Understanding the social determinants of health • How to determine the needs of the community • What population services organizations provide Terms to know: • Value-Based Care • Triple Aim Approach • Accountable Care Organizations (ACO's) • NHEA • Community Needs Assessment of hospital emergency departments with primary care providers" (Heiman, Artiga, 2015). As a part of this individualized system, a provider and a social worker would meet with patients to help identify and try to improve both medical and social needs. Upon receiving assistance with medical and social needs, it was found that hospital and emergency department utilization from these patients had significantly decreased. While it may not always be easy, it is extremely important that a community address the social determinants of health in order to improve overall population health. Since all communities may not be able to address each individual social need, it is crucial that communities attempt to address some of the population's social needs. By holding a job fair, opening a community-funded day care center, or creating a family-friendly park, a community could reduce even the slightest amount of stress on the population which would make all the difference in improving overall population health. What is one way that a community can address the social determinants of health? In 2010, with the new implementation of the Affordable Care act and Patient Protection Act, there were many new changes in the healthcare sector. One change, consisted of updating of the standards that nonprofit hospitals are required to meet in order to qualify for tax exemptions. One specific requirement includes conducting a Community Health Needs Assessment, as well as then developing an implementation strategy, every three years. A Community Health Needs Assessment consists of a long term written report plan that uses data to analyze and understand the health within a specific community. These assessments include information on risk factors, quality of life, mortality, morbidity, social determinants of health to assess the community health and prioritize the community's health needs as they can. This data is collected and used to develop and implement strategies to serve the communities' health needs and identify issues within the specific community. These assessments are followed with improvement plans or processes that work to address the specific health needs found in the assessments. Many of these improvement processes include developing new policies, collaborating with community partners, or designing and implementing new resources and services to benefit the community ("Definition of community health assessments…", n.d.) "The regulations require that the assessment address not only financial and other barriers to care but also the need to prevent illness; ensure adequate nutrition; and address social, behavioral, and environmental factors that influence the community's health or emergency preparedness" (James, et al., 2016). Any hospital that fails to comply with the community health needs assessment is subject to a $50,000 excise tax penalty.

Healthcare, 2018

Although there is a widespread belief that ACOs must be patient-centered to be successful, evidence to guide them in achieving that goal has been lacking. This case report examines four ACO innovators in patient-centered care that together represent urban, suburban and rural populations with a broad range of economic, racial, ethnic and geographic diversity. Seven patient-centeredness strategies emerged: transform primary care practices into patient-centered medical homes; move upstream to address social and economic issues; use both high-tech and high-touch to identify and engage high-risk patients; practice a whole-person orientation; optimize patient-reported measures; treat patients like valued customers; and incorporate patient voices into governance and operations. Exemplars prioritized direct care interventions perceived as central to financial and clinical success, and organizational maturity played a role. Activities that decreased the traditional system's authority, such as incorporating patient voices, were less popular. Local practice factors were important, and a mixture of mission and margin energized front-line staff in implementing patient-centered care as "the right thing to do." Unresolved questions remain that are related to the impact of individual and multiple interventions and how successful interventions can be disseminated widely. In order for patient-centeredness innovations to enable transformation, providers, payers and policymakers alike must consciously adopt strategies that nurture it.

Health Affairs, 2010

American Journal of Public Health

One of the 3 goals for accountable care organizations is to improve population health. This will require that accountable care organizations bridge the schism between clinical care and public health. But do health care delivery organizations and public health agencies share a concept of "population"? We think not: whereas delivery systems define populations in terms of persons receiving care, public health agencies typically measure health on the basis of geography. This creates an attribution problem, particularly in large urban centers, where multiple health care providers often serve any given neighborhood. We suggest potential innovations that could allow urban accountable care organizations to accept accountability, and rewards, for measurably improving population health. The United States has the highest per capita investment in health care of any nation in the world, 1 but the health of Americans is poorer than that of people in other industrialized nations. The United States ranks 36th for life expectancy and 39th for infant mortality, 2 and has a higher diabetes prevalence than any country in Western Europe. 3 Improving health in America will require a greater emphasis on public health programming because the delivery of medical care, which consumes most health-related spending, has a relatively modest impact on population-level measures of mortality. 4,5 As it happens, we are in the midst of reforming our health care financing and delivery system. Does this afford an opportunity to improve population health? A central instrument of reform is accountable care contracting, which occurs when a health care payer forms an agreement with an incorporated group of health care providers, called an accountable care organization (ACO), that commits to delivering an integrated range of health care services including prevention, care coordination, and disease management. The Patient Protection and Affordable Care Act 6 authorizes the Centers for Medicare and

Seton Hall law review, 2012