Officials from Johns Hopkins have released information on the cultural barriers and financial considerations for other academic medical centers in the establishment of accountable care organizations in an article published in the New England Journal of Medicine.
AMCs face considerable cultural barriers to ACOs, according to the report. AMCs have traditionally been comprised of autonomous departments, which may prove challenging when an ACO’s success is closely intertwined with interdepartment coordination. Also, the promotion and tenure systems within AMCs generally focus on faculty members’ grant support, publications and scholarly reputation rather than delivering high quality care. Finally, AMC ACOs may have difficulty ensuring adequate access to a large provider network, since AMC-based providers can spend 80 percent of time on research and 20 percent on clinical services if external grants allow.
AMCs should also conduct financial risk assessments before pursuing ACO status, since there are various models an ACO can adapt. A shared-savings model, for instance, requires the least risk and focuses on cost reduction to obtain a portion of the savings. The partial-capitation model requires some risk for the cost of services covered by Medicare, and the fully-capitated models involve the most risk with provider organizations receiving global payments for services.
The authors also suggested ACO pilots based on collaboration between health plans and physician groups. These pilots may effectively establish a smaller-scale ACO while laying the foundation for becoming an ACO under Medicare.
Read the NEJM report on accountable care organizations at academic medical centers.
Read more about accountable care organizations:
– 4 Tips for the Transition to ACOs
