Learning on the job: Johns Hopkins Medicine Alliance for Patients

December 14, 2015

Academic medical centers that take on community partners to form accountable care organizations face a number of unexpected challenges, says Scott Berkowitz, M.D., M.B.A., medical director of accountable care for the Office of Johns Hopkins Physicians and executive director of the Johns Hopkins Medicine accountable care organization (ACO) known as the Johns Hopkins Medicine Alliance for Patients (JMAP).

Twenty-two months after the inception of JMAP, Berkowitz and colleagues report on the startup experience in a "Perspective" article published recently in the journal Academic Medicine.

Information technology challenges, governance issues and provider engagement hurdles are among the barriers academic medical centers can expect when partnering in accountable care ventures, Berkowitz says.

"We've learned a lot in the first year-and-a-half of our ACO," Berkowitz says. "Changing our focus from one based on volume to one based on value requires some new ways of thinking. We're glad to share some of our initial findings."

JMAP is made up of the Johns Hopkins University School of Medicine, Johns Hopkins Community Physicians, The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital and Sibley Memorial Hospital. JMAP partners include Columbia Medical Practice, Potomac Physician Associates and Cardiovascular Specialists of Central Maryland. In all, nearly 2,900 providers care for 37,000 Medicare beneficiaries.

"We have been thrilled to be members of the JMAP team," says DeWayne Oberlander, CEO of Columbia Medical Practice. "Partnership in an ACO with Johns Hopkins has created the relationships and processes that have fundamentally changed the referral process and established the structure for collaborative working relationships. It is amazing to consider how far we've come, and we're looking forward to the important work ahead to improve the quality and efficiency of care."

In this piece, Berkowitz focused on academic medical centers in the Medicare Shared Savings Program, the most common type of ACO.

The generation and collection of data, Berkowitz says, were among the challenges Johns Hopkins Medicine faced in the early days of its ACO.

Both Johns Hopkins and its community partners in the ACO were in various stages of electronic medical records implementation. Training systems to communicate with one another is integral to long-term ACO success.

"The steps to receiving Medicare claims data and then the ability to use the data for analysis and risk prediction have taken nearly a year to implement," Berkowitz writes in the report. "Although one would hope to be able to leverage these powerful tools early on in the first performance year, the reality is that the complexity of systems can take time to properly navigate, and there is a need for upfront IT, analytic and electronic medical record expertise."

The ACO was a keystone of the Affordable Care Act, encouraging providers and hospitals to form networks that coordinate efficient patient care, keeping Americans healthier and reducing health costs at the same time. More than 7.2 million Medicare beneficiaries are covered by 405 Shared Savings Program ACOs across the U.S.

Berkowitz also points to the inherent tension for academic medical centers in moving to a population health model.

"Maintaining specialty referrals and a high hospital bed occupancy rate can still be consistent with the overall philosophy of keeping people healthy and out of the hospital when appropriate," Berkowitz says. "The goal is the right care, in the right place, at the right time."

The U.S. Department of Health and Human Services has said that a target of 30 percent of Medicare payments will be tied to quality or value through alternative payment models such as ACOs by the end of 2016 and that, by the end of 2018, one-half of payments will have this requirement.

Johns Hopkins Medicine

Related Health Articles from Brightsurf:

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

New measure of social determinants of health may improve cardiovascular health assessment
The authors of this study developed a single risk score derived from multiple social determinants of health that predicts county-level cardiovascular disease mortality.

BU study: High deductible health plans are widening racial health gaps
The growing Black Lives Matter movement has brought more attention to the myriad structures that reinforce racial inequities, in everything from policing to hiring to maternal mortality.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

E-health resource improves men's health behaviours with or without fitness facilities
Men who regularly used a free web resource made significantly more health changes than men who did not, finds a new study from the University of British Columbia and Intensions Consulting.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental health of health care workers in china in hospitals with patients with COVID-19
This survey study of almost 1,300 health care workers in China at 34 hospitals equipped with fever clinics or wards for patients with COVID-19 reports on their mental health outcomes, including symptoms of depression, anxiety, insomnia and distress.

Health records pin broad set of health risks on genetic premutation
Researchers from the University of Wisconsin-Madison and Marshfield Clinic have found that there may be a much broader health risk to carriers of the FMR1 premutation, with potentially dozens of clinical conditions that can be ascribed directly to carrying it.

Attitudes about health affect how older adults engage with negative health news
To get older adults to pay attention to important health information, preface it with the good news about their health.

Read More: Health News and Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.