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Accountable Care Organization Readiness and Academic Medical Centers

Berkowitz, Scott A. MD, MBA; Pahira, Jennifer J.

doi: 10.1097/ACM.0000000000000365

As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.

There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.

AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

Dr. Berkowitz is medical director for accountable care and assistant professor of medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, and executive director, Johns Hopkins Medicine Alliance for Patients, LLC, Johns Hopkins Medicine ACO.

Ms. Pahira is a graduate student and master’s in public health and master’s in business administration candidate, Johns Hopkins University, Baltimore, Maryland.

Funding/Support: Dr. Berkowitz receives partial salary support through the Johns Hopkins Community Health Partnership via grant number CMS-1C1-12-0001 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Disclaimers: The content with respect to this program is the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

Correspondence should be addressed to Dr. Berkowitz, Johns Hopkins School of Medicine, 600 North Wolfe St., Billings Administration 327A, Baltimore, MD 21287; telephone: (443) 287-4519; e-mail:

© 2014 by the Association of American Medical Colleges