Paper Published in Health Affairs

Newswise New Brunswick, NJ -- Providing quality patient-centered health care and controlling costs, all while adapting to health care reform, is the goal of a new accountable care organization (ACO) being created by the University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School. Researchers from the school report in a study published in Novembers issue of Health Affairs on the three-phase development of the ACO to date, the challenges it has faced and solutions to those challenges, and enabling factors that have contributed to its success so far. The lessons shared in the study can be used to assist other academic health centers and health care organizations in establishing new models of care that hold participating providers and systems responsible for managing care and controlling expenses. The study may be found through: http://content.healthaffairs.org/content/31/11/2388.abstract; a subscription may be needed to view the full text.

Health care reform means that academic health centers must change so they may preserve and strengthen their position as leaders in health care delivery, education and research, said Alfred F. Tallia, MD, MPH, professor and chair of family medicine and community health at Robert Wood Johnson Medical School. Clinical care supports most academic health centers; in order to maintain that capacity, medical schools must embrace and experiment with new efficient designs of health care delivery and payment. Academic health centers such as ours have a unique opportunity to reinvent themselves and lead the discovery and testing of new systems of health care organization and delivery. Accountable care organizations bring together in one system the different providers capable of caring for people from cradle to grave, and cover everything from advanced outpatient primary care to innovative cutting edge inpatient tertiary and quaternary care.

Drawing on 15 years of published research on transforming primary care practices conducted by the Family Medicine and Community Health division of research, the medical school initiated the process of creating the ACO in 2009. It established an integrated medical group, the Robert Wood Johnson Medical Group, with a common information platform and governance. The Robert Wood Johnson Medical Group implemented advanced primary care facilities, called Patient Centered Medical Homes (PCMH), in its outpatient primary care offices. This PCMH model of primary care is built around care delivery teams of physicians, nurses and mental health providers, as well as other health professionals who identify, coordinate, and treat acute and chronic conditions in high-risk populations.

By managing health care concerns of high-risk populations, we can reduce avoidable hospitalizations, and recurrent and expensive visits to the emergency room for health issues that can be more efficiently treated in outpatient settings, said Dr. Tallia. However, for accountable care organizations to be successful, they must provide high quality individualized patient care across the entire spectrum of health care, and that will lead to better outcomes.

The first phase of development included discussions with multiple stakeholders including providers -- both individuals and organizations -- such as hospitals, insurers, patients, consumer groups, government payers and policy makers, and researchers. The discussions resulted in an initial plan that includeds governance, infrastructure needs, clinical guidelines, and revenue and expense predictions.

Seeking feedback the plans developers shared it with local health care and government leaders, as well as hospital executives, during the second phase of creating the ACO, in order to ascertain their priorities, gain their support, and learn about challenges that needed to be overcome.

We cannot do it alone, said Dr. Tallia. Collaboration is essential to accountable care to ensure that we can keep people healthy, while also caring for them when they are sick.

The third phase is underway, as Robert Wood Johnson Medical School seeks the necessary start-up funding from private and public investors, as well as partner organizations in the Accountable Care Organization.

Obtaining financial support is one of the barriers the medical school has encountered in the creation of its ACO. Cultural differences and priorities among stakeholders and partners, as well as a lack of legal precedent involving ACOs, also have been obstacles. According to Dr. Tallia, resistance to change and skepticism about health care reform are consistent barriers that the medical school has worked to overcome to achieve a successful accountable care organization.

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Robert Wood Johnson Medical School Offers Insight, Discusses Barriers to Establishing an Accountable Care Organization