Rob Mechanic Highlights the Research of the Institute for Accountable Care

The Institute for Accountable Care has a massive database to understand which accountable care organizations (ACOs) are successful and why, as well as how best to implement accountable care programs, explained Rob Mechanic, MBA, senior fellow at the Heller School of Social Policy and Management at Brandeis University and executive director of the Institute for Accountable Care.

Transcript

What is the Institute for Accountable Care and its purpose?

The Institute for Accountable Care was started about a year ago. It was originally founded by NAACOS [National Association of ACOs], but it's a separate organization. We're an independent 501(c)(3) research institute; we have a separate board and our mission is really to approve the evidence base for accountable care models—not just ACOs, but accountable care writ large.

One of the reasons I was excited to join the Institute is because we have a massive database, which is a great research database where we can ask a lot of questions; and we don't just want to ask the question: Are ACOs saving money or not? We really want to understand which ACOs are successful, why are they successful, more specifically what are they doing that is working, and what are they doing that isn't working? So, what we want to do is help document what really are the best practices in accountable care, both make that available to the broader community—the policy community—but the other piece of what we're doing is working closely with ACOs to try to implement some of these models.

So, I'll just give an example, we have a grant from 3 foundations—the SCAN Foundation, The Commonwealth Fund, and the Robert Wood Johnson Foundation—and it is to establish a program—I'll call it an establishment program, it's really an implementation program—where we'll identify some specific initiatives to improve the care for high-need, high-cost individuals in ACOs. So, we have an advisory group of ACOs, we've been working on developing both a series of interventions and an implementation plan. We expect to, in early 2019, go forward; one stream is looking at nonmedical in-home visits, community health workers and paramedics that will help with trying to close gaps with social determinants of care and try to create a better connection between patients who may be socially and physically isolated back to their healthcare teams.

The second model is more of, I'll call it, an extensivist program and there are a lot of flavors of these. People probably think of the CareMore model, where you take people with very complex medical conditions and you have a multidisciplinary team—either in a separate clinic or a clinic inside a clinic—you identify the most complicated, sickest patients and you shower them with love and care, you go into their house, you have a dietitian, a pharmacist, nurse practitioners, a physician, and you really try to manage the most serious patients over a period of time get them stable and eventually get them back to their primary care provider. It's a really promising model. It's hard to do if you don't have some kind of a global budget model in place because again some but not all of the services are billable. But we think this is really a direction the healthcare system needs to go in terms of caring for these really vulnerable people.

So, we're excited we're going to develop a lot of outside partnerships with universities and research institutes, because we do have rich data and we do have great relationships with ACOs that are trying to do this work, so we're really excited about the future of the institutes and the kind of work we're going to do.