As the provisions of the Affordable Care Act go into effect, there has been a lot of talk about implementing accountable care. But there’s been an equal amount of discussion to figure out what that actually looks like in practice. The Children’s Hospital of Philadelphia has officially gotten accreditation as an accountable care organization — the first children’s hospital in the country to receive it.
ACOs coordinate doctors, hospitals and other health care professionals to deliver care and reduce waste and inefficiency. It’s an expansion of a Patient Centered Medical Home to include additional services that the organization can be accountable for such as inpatient, post-acute and other kinds of care. Primary care physicians within ACOs are the first point of contact for patients. They coordinate patient care across providers, identify and and manage high-risk patients, manage medications and track test results and follow-up care.
Hospitals that get ACO accreditation have to demonstrate several things, according to the website for National Committee of Quality Assurance that provides the accreditation:
- Ensure access to care
- Protect patient rights, including privacy
- Provide a solid foundation of patient-centered primary care
- Have care management and coordination capabilities.
- Monitor practice patterns and use performance data to improve quality.
- Use decision supports to help patients and providers identify the best care.
- Have necessary stakeholder participation, structure, contracting and payment arrangements.
In a phone interview with CHOP’s Chief Medical Officer Dr. Michael Apkon, he said that a children’s hospital was particularly well-suited to be an ACO.
“Children by and large are healthier and don’t need as much healthcare, so there are fewer high-end specialists. Pediatric care tends to be more integrated and because of that, care is less fragmented. Children’s hospitals really do become anchors of care. As soon as you need a pediatric specialist, pediatric radiologist or pediatric intensive care specialist that care is centered in a smaller number of places. Adults can find specialists in almost any community but with pediatrics, care is concentrated around 50-100 hospitals. Most of the costly, morbidity-producing illnesses are conditions children are born with, so the nature of care is more longitudinal and complex. You need multiple disciplines to solve the problem.”
CHOP is among the largest, integrated networks for health care delivery for children in the country. Apkon said it wanted the NCQA accreditation to demonstrate its commitment to providing more responsible, efficient care. The accreditation sets objectives for CHOP and gives it a roadmap to achieve them.
Apkon said the provider’s organizational structure of integrated care has been in development for the past 12 years and includes a network of 24 primary care practices, which are also accredited patient centered medical homes. It also works with 12 community hospitals. One example of the integrated care it provides can be seen is through its its work with primary care physicians caring for children with complex medical conditions. They can see notes specialists write and X-rays that have been taken to help reduce duplication in testing, and that leads to better decision making.
As part of CHOP’s new status, it’s required it to be more transparent and requires it to publicly report its performance and make performance reports available to providers for quality improvement. It will also help help purchasers and providers identify effective partners, according to a statement from the hospital. It also helps patients find physicians who are committed to providing the quality care they need, when they need it.
CHOP is part of a group of health systems and plans that were the first to get national accreditation. The group also includes: Kelsey-Seybold Clinic — a group of specialty clinics based in Houston, Texas; Essentia Health in Minnesota, Crystal Run Healthcare — a multipractice physician group in the Hudson Valley in New York; and Health Partners in Bloomington, Minnesota.
The Children's Hospital of Philadelphia certainly deserves the honor of being the first children's hospital to receive ACO status, however, one might question why School nurses are not yet included as a part of the process of receiving such a designation. School nurses spend more time with children with chronic illnesses who attend school than any other health care provider. Yet in most areas of the country, school nurses are not yet considered part of the integrated health team system that is an important part of the Medical Home concept of care. In Philadelphia, school nurse positions have been cut as cost-saving measures for the school districts, leaving the remaining nurses overburdened and outside the loop of healthcare. If school nurses were tied into the integrated health team, linked by EHR, then the circle of the children's access to care would be complete. The state of Delaware has successfully piloted such a program and is expanding it to all schools. Their model should form a basis upon which all school districts across the country should refer to for guidance in setting up a system that would truly ensure quality and timely access to care for children.