NYAPRS Note: Here’s a fascinating view at what some say is the next step in healthcare transformation: moving from accountable care provider networks to accountable care communities. The following comes from Trust for America’s Health (TFAH)’s new report, A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years,“whichprovides high-impact recommendations to prioritize prevention and improve the health of Americans. TheHealthier Americareport outlines top policy approaches to respond to studies that show 1) more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented, and 2) that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.”
Here’s a link to the one for New York City: http://healthyamericans.org/assets/files/TFAH2012InvstgAmrcsHlthNYC.pdf
Akron, Ohio - The First Accountable Care Community In Action
Looking for ways to improve the vitality - particularly the economic vitality - of the community, leaders in Akron, Ohio identified health issues - particularly high rates of chronic disease and related health care costs - as a major concern.
The nonprofit ABIA brought together a wide range of 70 different groups to launch the first-of-its-kind Accountable Care Community in 2011.
The ACC is focused on improving the health of the community and incentivizing the health care system to reward improved health while delivering cost effective care. Success is measured by factors including the improved health of the whole community, cost effectiveness and cost savings in the health care system, improved patient experience for those using the health care system and job creation in Akron.
The effort began by zeroing in one of the most widespread, high cost preventable health problems in their community: type 2 diabetes.
Approximately 11 percent of adults in Akron have diabetes, and 2.1 percent more are considered pre-diabetic and are at risk for developing full blown diabetes.
If current trends continue, one-third of the Akron population could have diabetes by 2050.
Of the individuals with type 2 diabetes involved in Akron’s ACC, around 38 percent have private health insurance, 31 percent have public health insurance (Medicare or Medicaid) and 31 percent have no health insurance. People with diabetes have 2.3 times higher average medical costs per year than non-diabetics.
Effective approaches to prevent and control diabetes require a comprehensive approach.
Strong, regular medical care, including coverage for care, is important. But, daily self-management is also essential for individuals with diabetes. And, maintaining a healthy diet and levels of physical activity are also necessary to help those with diabetes improve their health and prevent others from developing diabetes in the first place.
There is recognition that health care must focus on improving the overall health of individuals, which requires thinking about their direct care but also how to coordinate maintaining health outside the doctor’s office. Managing health in daily life requires having information about nutrition and activity and proper self-management education for those who are living with health conditions. In addition, it is important to make healthy choices easier in people’s daily lives. This includes easier access to affordable healthy food, safe and convenient places for physical activity, mental and emotional support, and encouragement and incentives from employers, family, community- and faith-organizations and others.
The ACC built a collaboration to leverage the resources and ideas of a wide range of organizations, including the major hospitals and health care providers, employers, the Chamber of Commerce, universities, housing groups, transportation groups, economic developers and planners, a range of faithbased organizations and many others. Some of the activities and initiatives, in addition to those directly related to education and care for disease, have included community gardens, fresh food preparation, fit-minute exercise, among others.
Akron has worked on the following initiatives: (1) expansion of the concept of “public lands for public health” with the Cuyahoga Valley national Park - including extending public transportation such as bus lines to make the park more accessible to more members of the community; (2) a regional health impact assessment of the Akron Marathon; (3) partnerships with the faith-based community for health education and screening for individuals who are underserved including refugees and native-Americans; and (4) work with the Akron Metropolitan Transportation System to better understand how to design or redesign systems transportation and the built environment to provide increased opportunities access safe places for physical activity and healthy, affordable food options.
The initiative also received a CTG from CDC to help support their activities. CTGs are awarded to communities that are taking integrated, evidence-based approaches to preventing disease. ABIA received a $500,000 per year for five years capacity-building grant in 2011.
The three major community health systems, the Akron Children’s Health System, Akron General Health System, and Summa Health System and many private provider groups in Akron participate in the ACC. Combined, around 80 percent of all of the county’s population are represented through participating hospitals, providers and social service agencies. The initiative recognizes that knowledge and information management is essential to understanding and analyzing health and cost patterns. They have developed systems for confidential sharing of patient data using an integrated data platform, which allows for the consistent and comparable analysis of data to be able to track health trends and cost savings. Participating hospitals and providers receive a share of the health care cost savings achieved by the program, and other funds are reinvested in the ACC or other community efforts.
In just 18 months, the initiative is already seeing positive results:
- The average cost per month of care for individuals with diabetes was reduced by more than 10 percent per month; and
- After one year of involvement, consistent reductions in costs are in excess of 25 percent.
Other key highlight outcomes include:
- Estimate program savings of $3,185 per person per year;
- More than half of participants lost weight (115 pounds), decreased decreased body mass index (BMI) (almost 23 points), and reduced waist size (more than 25 inches);
- Lowered cost per person per contact hour with health care providers ($25 vs. $37.50 for other leading diabetes prevention programs);
- Better management leading to decrease in glycated hemoglobin (A1C) (a measure of diabetes) and LCL cholesterol (often known as “bad” cholesterol) levels;
- no amputations because of diabetes;
- decline in emergency department visits because of diabetes:
- a drop from nine to six emergency room visits for people in the higher glycated hemoglobin ranges (HbA1c>8%); and a drop from six to three visits for people in the lower glycated hemoglobin ranges (HbA1c<8%); and
- Increase in reported exercise and flexibility.
The ACC has been successful in improving quality of care, lowering the cost of treatment, delaying the progression of disease, expanding the population receiving comprehensive care, reducing the overall burden of disease in the community, and increasing productivity. The initiative is planning to expand to focus on additional health problems, such as asthma.
Akron is a healthier place with lower health care costs because of the ACC, and it is more attractive to businesses and other groups because of its more vibrant and productive workforce.
ABIA developed the ACC model so it could be replicated in other communities around the country, and has had more than 200 requests for more information or consultation from other communities.
Health Systems and Healthcare providers
Safety-net Health Services
Mental Health Services
National Health Coalitions
Government and Philanthropy
Austen Bioinnovation Institute In Akron
ABIA is a unique biomedical innovation institute, founded in 2008 by Akron Children’s Hospital, Akron General Health System, northeast Ohio Medical university, Summa Health System, The university of Akron and the John S. and James L. Knight Foundation. The City of Akron and the County of Summit are key participants in the initiative.
“As we think about the Accountable Care Community, we have the opportunity to impact quality of life, and also the economic vitality of our community, not only for us but also serving as a national model and transporting to other parts of the United States.”
- Janine E. Janosky, Ph.d., vice president, head, Center for Community Health Improvement, ABIA Akron - SOME VITAL STATISTICS FROM County HEALTH Rankings And Roadmaps (2012)
From RWJF and THE University OF Wisconsin Population Health Institute
- 11 percent of adults have diabetes
- 30.4 percent of adults are obese and an additional 37.3 percent are overweight*
- 21 percent of adults smoke
Health Care Facts
- 14 percent of adults have not had health care insurance
- $9,749 average health care costs per adult per year
- 540,000 approximate Summit County, Ohio (Akron) population
- 24.8 percent of adults are physically inactive
- 77.7 percent consume less than the recommended five servings of fruits and vegetables a day*
- 57 percent of restaurants in the county are fast food restaurants
- 86 percent of working adults commute alone to their jobs
- 19 percent of adults have inadequate social support
- 9.9 percent of adults are unemployed
- 22 percent of children live in poverty
- $45,768 is the median household income
- 34 percent of residents pay 30 percent of more of their income on housing
*Source: ABIA White Paper