Dr. Berkowitz is medical director for accountable care and assistant professor of medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, and executive director, Johns Hopkins Medicine Alliance for Patients, LLC, Johns Hopkins Medicine ACO. Ms. Pahira is a graduate student and master's in public health and master's in business administration candidate, Johns Hopkins University, Baltimore, Maryland.
Acad Med. 2014 Sep;89(9):1210-5. doi: 10.1097/ACM.0000000000000365.
As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.
随着学术医疗中心（AMC）考虑在医疗保险下成为责任医疗组织（ACO），他们必须评估其为此转型做好准备的情况。在 2014 年之前的 253 个医疗保险 ACO 中，有 51 个（20%）是 AMC。ACO 准备工作的三个关键组成部分是机构和 ACO 结构、领导力和治理；强大的信息技术和分析系统；以及协调和管理护理以改善人群层面的护理提供和健康。所有这些都必须通过 AMC 以使命为导向的目标的视角来看待。在 ACO 内部推动变革时，制定和维护集中的内部领导力显然是有益的，但也需要广泛的利益相关者参与。其他重要的结构特征是广泛的初级保健基础；同时运营管理式医疗计划或风险承担实体；或与后期急性护理或熟练护理设施保持密切关系，这些设施在协调整个护理过程方面提供了宝贵的专业知识。ACO 还需要全面和综合的数据和分析系统，为护理团队实时提供有意义的人群数据，促进质量改进，并监测支出趋势。AMC 将需要在人口健康框架内实施经过验证的护理协调和管理策略，并部署创新型劳动力。
AMC 的核心职能是提供高质量的专科和初级保健、产生新知识和培训未来的医疗保健领导者，可以很好地与向 ACO 模式的转变保持一致。对医疗保险相关 ACO 计划和商业 ACO 的结果进行进一步研究将有助于确定最佳实践。
