The Future of Healthcare Delivery: Top 10 AJAC Articles

The American Journal of Accountable Care (AJAC) publishes research and analysis that encourages the sharing of best practices to ensure the improvement of healthcare quality. This year, papers explored accountable care organizations (ACOs) and other emerging care models that provide accountable and patient-centered care as the healthcare environment in the United States moves to value-based payment models.

These 10 articles exploring the future of healthcare delivery were the most read from AJAC in 2015.

10. Meaningfully Engaging Patients in ACO Decision Making

Researchers from Johns Hopkins outline a 3-step framework for ACOs to ensure they are incorporating patients' needs, values, and preferences into governance decisions. The purpose of the framework is to get ACOs to more meaningfully engage patients.

9. The Emerging Business Models and Value Proposition of Mobile Health Clinics

Despite the growth in the utilization of mobile health clinics to deliver care to urban and rural populations, they remain an underutilized resource. Researchers discuss the value of mobile health clinics as well as propose 3 business models: adoption by accountable care organizations, payers, and employers.

8. The Need to Level the Playing Field Between Accountable Care Organizations and Medicare Advantage

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http://www.ajmc.com/journals/ajac/2015/2015-vol3-n4/the-need-to-level-the-playing-field-between-accountable-care-organizations-and-medicare-advantage

David Introcaso, PhD, made the case that Medicare Advantage (MA) hinders the Medicare Shared Savings ACO program. There are 3 particular reasons why this is: MA plans are expected to increase enrollment, MA markets are highly concentrated, and MA plans have more favorable program rules.

Dr Introcaso claimed that in order to successfully establish ACOs as alternative payment models, CMS needs to level the playing field in Medicare for ACO providers.

7. The Healthcare Revolution Will Be Digitized

With the move to value-based models, providers and healthcare organizations share risk, which necessitates sharing data in order to be successful. Brian Ahier wrote that surviving and thriving in this new healthcare system will require clinicians have access to timely and correct information at the point of care.

6. AJAC Interviews Sachin H. Jain, MD, MBA, Chief Medical Officer, CareMore

Sachin H. Jain, MD, MBA, recently joined Anthem’s CareMore Health System as its chief medical officer. In this Q&A, he discusses his decision to join CareMore, CareMore’s innovative care model, and his perspectives on US healthcare.

5. A Physician-led Accountable Care Organization: From Award to Implementation

Physician-led ACOs are experiencing greater growth, and researchers identified gaps to determine the readiness of a group of independent physicians to implement an ACO. According to data collected from a questionnaire as well as interviews, the authors noted that the most common gaps in ACO readiness were lack of human and fiscal resources, few care management tools, and underutilization of health information technology.

4. The Arkansas Payment Improvement Initiative: Early Perceptions of Multi-Payer Reform in a Fragmented Provider Landscape

The Arkansas Payment Improvement Initiative, a multi-payer model combining patient-centered medical homes with episodic payments, was implemented in an effort to accelerate the state’s move from fee-for-service. The researchers determined that not only has the feedback from stakeholders as so far been positive, but that the model could have apply to other states that have largely rural and fragmented delivery systems.

3. Value-Based Purchasing Versus Consumerism: Navigating the Riptide

In this commentary, Leah Binder, MA, MGA, president and CEO of The Leapfrog Group, took a look at the expanding surge of consumerism, and how it may run counter to the Affordable Care Act’s aim of incentivizing providers to better manage care.

2. Is the Medicare Bundled Payments for Care Improvement Initiative Designed to Succeed?

CMS’ Bundled Payments for Care Improvement initiative is one of the largest demonstrations in Medicare history. According to researchers, the high interest in the program is an encouraging sign for Medicare’s transition from fee-for-service to episode-based payment.

In interviews with participants, the authors found that opportunities to examine data for episodes of care that extend beyond their own organization have led to new observations and insights.

1. Lessons From CareMore: A Stepping Stone to Stronger Primary Care of Frail Elderly Patients

CareMore has developed an integrated patient care delivery system designed to surround patients with care with extensivists, hospital-based physicians who see patients for follow-ups, nurse practitioners, and nurse care managers. The system has provided better outcomes at lower costs with patients experiencing 42% fewer hospital admissions than the national average and per member per month spending less than expected under a CMS model for similar risk patients.