S.A. Berkowitz is senior medical director of accountable care, Office of Johns Hopkins Physicians, and assistant professor of medicine, Division of Cardiology, both at Johns Hopkins University School of Medicine, Baltimore, Maryland. He is also executive director, Johns Hopkins Medicine Alliance for Patients, LLC, Glen Burnie, Maryland. L. Ishii is associate professor and director of research of facial plastic and reconstructive surgery, Department of Otolaryngology-Head & Neck Surgery, senior medical director of clinical integration, Office of Johns Hopkins Physicians, and medical director, Johns Hopkins White Marsh Surgery Center, all at the Johns Hopkins University School of Medicine, Baltimore, Maryland. J. Schulz is a third-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland. M. Poffenroth is chief medical officer, Signature Partners Network, Inova Health System, Fairfax, Virginia. He is also former medical director, Johns Hopkins Medicine Alliance for Patients, LLC, Glen Burnie, Maryland.
Acad Med. 2016 Mar;91(3):328-32. doi: 10.1097/ACM.0000000000000976.
Academic medical centers (AMCs)--which include teaching hospital(s) and additional care delivery entities--that form accountable care organizations (ACOs) must decide whether to partner with other provider entities, such as community practices. Indeed, 67% (33/49) of AMC ACOs through the Medicare Shared Savings Program through 2014 are believed to include an outside community practice. There are opportunities for both the AMC and the community partners in pursuing such relationships, including possible alignment around shared goals and adding ACO beneficiaries. To create the Johns Hopkins Medicine Alliance for Patients (JMAP), in January 2014, Johns Hopkins Medicine chose to partner with two community primary care groups and one cardiology practice to support clinical integration while adding approximately 60 providers and 5,000 Medicare beneficiaries. The principal initial interventions within JMAP included care coordination for high-risk beneficiaries and later, in 2014, generating dashboards of ACO quality measures to facilitate quality improvement and early efforts at incorporating clinical pathways and Choosing Wisely recommendations. Additional interventions began in 2015.The principal initial challenges JMAP faced were data integration, generation of quality measure reports among disparate electronic medical records, receiving and then analyzing claims data, and seeking to achieve provider engagement; all these affected timely deployment of the early interventions. JMAP also created three regional advisory councils as a forum promoting engagement of local leadership. Network strategies among AMCs, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.
学术医疗中心（AMC）——包括教学医院和其他医疗服务提供实体——如果要组建责任医疗组织（ACO），就必须决定是否与其他服务提供实体（如社区诊所）合作。事实上，据信在截至 2014 年参与联邦医疗保险储蓄计划的 AMC ACO 中，有 67%（33/49）的 AMC ACO 都与外部社区诊所合作。这种合作关系对 AMC 和社区合作伙伴都有机会，包括围绕共同目标进行可能的调整，并增加 ACO 的受益人群。为了创建约翰霍普金斯医学联盟（JMAP），约翰霍普金斯医学于 2014 年 1 月选择与两家社区初级保健集团和一家心脏病学诊所合作，以支持临床整合，同时增加大约 60 名医疗服务提供者和 5000 名联邦医疗保险受益人群。JMAP 的最初主要干预措施包括为高风险受益人群提供护理协调，后来在 2014 年，生成 ACO 质量指标仪表板，以促进质量改进和尽早采用临床路径和明智选择建议。2015 年开始实施更多的干预措施。JMAP 面临的最初主要挑战是数据整合、在不同的电子病历中生成质量指标报告、接收和分析索赔数据，以及寻求实现医疗服务提供者的参与；所有这些都影响了早期干预措施的及时部署。JMAP 还创建了三个区域咨询委员会，作为促进当地领导力参与的一个论坛。AMC 之间的网络策略，包括在非就业模式下增加社区诊所，将继续需要深思熟虑的战略规划和对当地情况的深刻理解。
