The ‘Promise’ of Accountable Care

“They’ve all come to look for America”

America – Simon & Garfunkel

Last week I was in San Diego speaking at The Johns Hopkins University 2016 ACG® System International Conference. The conference attracted delegates from all over the world, including the US, Sweden, Italy, South Africa and the UK. In all cases, delegates and speakers were exercised with the challenge of delivering the ‘Triple Aim’:

  • Better health outcomes
  • Better patient experience
  • Reduced cost

While the approaches to addressing this rather large topic differed in detail, a common theme was the need to leverage the available data in order to provide insights that might support transformation programmes. Believe me, the language of New Care Models is not unique to the UK.

The title of my own presentation was ‘Let’s share the data and analyse the hell out of it because we all might learn something.’ We may well be two nations divided by a common language but I think they got the point.

One of the most striking speeches that week was from Dr Linda Dunbar, Vice President Population Health at Johns Hopkins Healthcare (JHHC). JHHC is an Accountable Care Organisation (ACO) offering a model of community based accountable care. It does this through a body called the Johns Hopkins Community Health Partnership (JCHIP) and the key word here is partnership.

I was particularly attentive during this part of the conference because the subject of Accountable Care is of course very much in vogue in the UK at the moment. Some of the current Vanguards — Northumberland being prominent — talk very openly about their journey towards becoming an ACO. I was more than keen, therefore, to hear the US experience.

As far as this ACO in the US is concerned, there is no ‘silver bullet’ just a lot of hard work and a lot of focus on shifting the culture. Dr Dunbar was very careful and precise in her use of language. It was telling I thought that she referred to Accountable Care Organisations as holding ‘promise’ for improving the effectiveness and efficiency of care delivery.

Most interesting were the results she shared of Medicare Shared Savings ACO Performance. A feature of the Medicare Shared Savings Program is that if participating ACOs meet quality benchmarks and keep spending below (capitated) budget, they receive half the savings that result. The remainder goes to Centres for Medicare and Medicaid Services (CMS).

Reporting from the programs first year of operation in 2013, results were mixed. In 2013 there were 220 shared savings ACOs in the US and the results are as follows:

  • Only 52 (24%) were able to meet quality of care benchmarks and keep spending below budget targets.
  • 60 ACOs (27%) kept spending under target but did not fulfil their requirements to measure the quality of care delivered or did not reduce spending enough to meet the criteria to share in savings.
  • 102 (46%) did not achieve savings at the target, but met quality targets.
  • 6 (3%) achieved savings but did not report quality measures.

Plenty of food for thought here. It occurs to me that the Vanguards here are right to describe their current endeavours as a journey.

The other three big takeaways from Dr Dunbar’s presentation were:

  • The need to use data to understand how to best invest shared resources to produce the best health outcomes.
  • The need for transparency in the application of that data.
  • The importance of the collection and use of data on social and environmental factors as they are related to risk identification and health outcomes. Dr Dunbar spoke eloquently about the need for new uses of shared data sources that included social determinants of health.

Important learnings then from some very dedicated individuals who are already fighting at the frontline of accountable care.

And if you thought there was a challenge here in the UK securing the necessary data, then believe me our travails here are as nothing compared to the US. We are blessed by comparison. It just doesn’t feel that way.

But that’s a story for another day.