Health Care Innovation Zones: An ACO for AMCs?

Julie Schulz, MD, Consultant, Sg2 , April 7, 2011

As of the writing of this post, it is unclear how (and if) HIZ pilot projects will be funded. The CMI has $10 billion to use at its discretion for the plethora of pilots proposed in the PPACA and may use it to provide seed funding for HIZ projects. However, the CMI is currently juggling many responsibilities with a small staff and partisan wrangling over defunding health care reform continues. Although the fate of HIZs is uncertain, they share much in common with ACOs, which continue to pick up momentum. While successful ACOs will require a strong foundation of primary care, most AMCs have emphasized tertiary and quaternary care. Future ACOs (and HIZs) will likely give AMCs the role of a “center of excellence” for patients who require specialty care beyond the scope of what community ACOs can provide. Thus, AMCs could have multiple contracts with different ACOs that refer to the AMC for tertiary and quaternary care. A surefire strategy for AMCs in the short- to mid-term includes the following actions:

Strengthen core competencies as “centers of excellence.” Take a disease-based approach to determine in which service lines, procedures or specialties your AMC excels—not every AMC can be a center of excellence in everything! Invest in these areas for sophisticated, high-margin care and strengthen the referral networks that bring in patients for these services.

Learn to partner with primary care providers and post-acute care providers. AMCs should establish a coordinated, collaborative approach to transitioning patients between sites of care. Tools to improve coordination include:

  • A service culture in which both the patient and the referring physician are seen as high-value clients of the AMC.
  • An electronic medical record that interfaces with both the primary care office and the AMC.
  • Nurse navigators and patient coordinators who facilitate communication between sites of care, providers and patients.
  • Clear guidelines for primary care and community sites on how to perform tests such as biopsies, imaging studies and other first-line treatments prior to transferring patients to the AMC. Primary care/community health sites and AMCs should develop these guidelines together.
  • Clear referral pathways specifying to which provider the patient will be referred.
  • Clear guidelines for post-acute care and effective communication regarding patients’ care plans.
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