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On the Cutting Edge of Accountability in Cleveland

by Caroline Smart, CloudView Editor

Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic's best storytelling on America’s population health revolution. To catch up on our series, you can find last week’s story here. Today, we explore how the interconnectivity one one health system in northeast Ohio addressed Cleveland's vast health care needs.

Patients slip unnoticed through cracks in the system, while doctors and hospitals are paid based on services and procedures rather than the quality of the care they provide.  Cleveland, Ohio’s University Hospitals (UH) is on a mission to address and eliminate these two most common complaints about healthcare in the United States. 

UH, along with a growing number of healthcare systems across the country, is taking up the fight by forming accountable care organizations (ACOs)—an increasingly popular healthcare model in which networks of specialists and primary care physicians collaborate with public health officials to address the health of communities, as well as individuals. Armed with vast pools of data on health risks in a community, such as the incidence of asthma among children or diabetes among immigrants, the ACO can focus its attention on healthcare problems before they become endemic—and costly.

By emphasizing preventive care through population health management in the community, ACOs aim to keep people from getting sick and to deal with health issues quickly (and close to home).  And by focusing on patient outcomes rather than the number of procedures performed, ACOs are showing they can “bend the cost curve” for healthcare in America.  In ACOs, the healthcare providers, including hospitals, are compensated based not only on the quality of their outcomes and their adherence to best practices but also on the savings captured as a result.

Since 2010, when its ACO first launched, UH has grown into one of the largest accountable care organizations in the country. Its collection of ACOs now cares for more than 300,000 people in the region, including Medicare and Medicaid beneficiaries, the self-insured, and those covered by commercial insurers.

But in 2012, UH gave new meaning to the ACO’s focus on preventive care for high risk populations by establishing an ACO specifically for children and young adults from low-income households. The Rainbow Care Connection (UHRCC) was borne out of a $12.7 million Health Care Innovations grant from the Center for Medicare & Medicaid Innovation to UH Rainbow Babies & Children’s Hospital.  It now delivers care to a Cleveland-based population of 70,000 children who are covered by Medicaid.

Some of those children have complex, chronic conditions that require constant medical attention. Under the Rainbow grant, teams of “comprehensive care” providers surround each patient to deal with the medical, social, and emotional problems faced by the children and their families.

For University Hospitals, team-based “connected care” is a baseline principle. That’s why they expanded their focus to ensure patients get quality care, even when they’re not in front of a UH doctor or in a UH facility, and to leverage their health infrastructure to take the appropriate action.

Through its ACOs, University Hospitals is building that infrastructure in almost every way imaginable. And while there is no silver bullet for Cleveland, where widespread unemployment and poverty conspire to produce high rates of infant mortality and obesity, they have given the city an arsenal with which to fight back.

In a dense, urban environment like Cleveland, the range of health needs is highly diverse, and data on health indicators in different geographic and demographic communities is too often tangled, uncoordinated, or silo-ed by the organizations that collect it.

University Hospitals decided that each of its ACOs would have to connect the dots, compiling data from Medicare and Medicaid, private insurance companies, local providers, and patient records. To its partners among independent hospitals and other local providers, who often know the needs of their communities better than anyone, UH provides the specialists, technology, infrastructure, and data-processing capability necessary to devise best practices and achieve optimal outcomes for their patient populations.

Cleveland’s health needs and gaps in care tightly correlate with factors such as lack of transportation, education, or income, according to the region’s Community Health Needs Assessments. Putting together various sources of data allows the ACO to find places where such problems are most acute and deploy targeted programs to address them—in effect, working to prevent medical issues before they have to be treated.

Instituting the ACO model and effective population health management across the sprawling University Hospitals system has been arduous and vastly complex, but the payoff from all that work is easy to see. 

Caroline Smart is a Senior PR Associate and CloudView Editor.

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