“Accountable Care Community (ACC): a collaborative, integrated, and measurable multi-institutional approach that emphasizes shared responsibility for the health of the community, including health promotion and disease prevention, access to quality services and healthcare delivery. The ultimate goal of the ACC is a healthier community.” (Source: Healthier by Design: Creating Accountable Care Communities)
In health care, these are exciting times – or, some may say, frightful! For the purposes of this newsletter, let’s stay on the positive side of the transformation and change underway. For the first time, the work of health-care providers and communities can be formally linked and measured in tangible ways.
At NCFAHP’s Board of Directors retreat in November 2012, we began to consider our role in facilitating the development of a new Accountable Care Organization (ACO) model: a model that would include the expertise and services from community partners from the start of the ACO. Too often, ACOs create new services and hire providers to provide health and wellness services, health coaching, etc., rather than relying on community partners. Adding new service lines and providers seems unnecessary when the community is the better choice.
To date, meaningful participation of community health partners in these models has been lean, or often nonexistent. But Akron, OH, has been a pioneer in a new model that takes fuller advantage of community-based partners – an Accountable Care Community (ACC). A 2012 report by Austen BioInnovation Institute cites Community Care of NC as an early model of this approach. Akron’s model takes it one step further by including local growers to provide fresh fruits and vegetables and the National Park system to provide opportunities for better health through walking, kayaking or other physical activity.
The Institute reports that, while the Accountable Care Community may share characteristics with the ACO, there are also factors distinguishing the two:
- “ACC encompasses not only medical delivery systems, but the public health system, community stakeholders at the grassroots level and community organizations whose work often encompasses the entire spectrum of health.
- ACC focuses on the health outcomes of the entire population of a defined geographic region, rather than a defined and targeted population of health consumers selected by an ACO for their efforts at payment and care delivery reform.”
Natural systems of community care do not follow prescribed patterns of grouping community members together by patient type, but they do organize themselves and health behaviors according to the culture, leadership and priorities within the population. The ACC simply makes sense. Furthermore, as Dr. Janine Janosky, Vice President, Center for Clinical and Community Health Improvement at the Institute states: “As we think about the Accountable Care Community, we have the opportunity to impact the quality of life, and also the economic vitality of our community…”
At NCFAHP, the programs are designed to fit together and complement one another for the purpose of filling gaps to create relationships, services, training, and data compilation that do not “fit” in other places. Workforce data to power the decisions in local communities to actively participate in the recruitment and, most importantly, retention of health-care providers is essential to the ACC. Jackie Fannell’s work with Practice Sights provides some insight to this work.
Since October 2014, the Foundation’s Bernstein Fellows program has emphasized the Fellows’ leadership role in creating accountable care communities. Communities are overwhelmed by the intricacies of the Accountable Care Organization model and see the opportunity and need for their participation in this complex structure. The Fellows are engaged and interested in creating a “place at the table” in their own communities and across North Carolina.
Part of the NCFAHP vision is to engage in innovation to:
- Create strategies that significantly affect existing systems
- Build on emerging elements within existing systems
- Create new systems or strategies by creating partnerships resulting in unique opportunities to combine/refine services and resources
- Improve on existing strategies or systems
The Fellows Program faculty includes individuals and organizations interested in promoting the ACC model across North Carolina. True to the model, NCFAHP is not interested in duplicating the work of our colleagues, but instead leveraging the work to heighten awareness and create momentum. We would like to thank the following individuals for providing inspiration and information to the Fellows:
- Patrick Woodie, President, NC Rural Center, Misty Herget, Director of Leadership and Chilton Rogers, Director of Community Engagement
- Ruth Petersen, MD, MPH, NC Division of Public Health, Section Chief for the Chronic Disease and Injury Section.
- Greg Randolph, MD, MPH, Director of the Center for Public Health Quality and Professor of Pediatrics and Adjunct Professor of Public Health at the University of North Carolina at Chapel Hill.
- Grace Terrell, MD, CEO Cornerstone Health Care, P.A. a multiple specialty medical group in the Piedmont Triad region of North Carolina with more than 370 providers and 1800 employees who practice at fifteen separate hospitals.
- Chris Collins, Director, NC Office of Rural Health and Community Care
- Julian Bobbitt “Bo”, Partner, Smith Anderson Law Firm
- Robin Tutor-Marcom, MPH, OTR/L, Director, NC Agromedicine Institute, East Carolina University
- Kellan Moore, MPH, Executive Director and Willona Stallings, MPH, Care Share Health Collaborative
- Kim Schwartz, MA, Chief Executive Officer, Roanoke Chowan Community Health Center
- E. Benjamin Money, Jr., MPH, President and CEO, NC Community Health Center Association
The Accountable Care Community is the “glue” bringing these elements together in a comprehensive manner. Accountable Care Communities is a “whole- person, whole- community approach.”
The work continues with this team. Stay tuned, more to come!
CEO & President