Updated by, Janine E. Janosky, Ph.D., Vice President, Head, Center for Community Health Improvement, Austen BioInnovation Institute in Akron
In 2011, Austen BioInnovation Institute (ABIA) in Akron, Ohio brought together a wide range of more than 70 different groups to launch the first-of-its-kind Accountable Care Community (ACC).
The ACC is focused on improving the health of the community and incentivizing the health system to reward improved health while delivering cost effective care. Success is measured by factors such as the improved health of the whole community, cost effectiveness and cost savings in the healthcare system, improved patient experience for those using the healthcare system, job creation in Akron, and more.
The effort began by zeroing in one of the most widespread, high cost preventable health problems in their community: type 2 diabetes. Approximately 11 percent of adults in Akron have diabetes, and 2.1 percent more are considered pre-diabetic and are at risk for developing full blown diabetes. People with diabetes have 2.3 times higher average medical costs per year than non-diabetics. If current trends continue, one-third of the Akron population could have diabetes by 2050.
Of the individuals with type 2 diabetes involved in Akron’s ACC, around 38 percent have private health insurance, 31 percent have public health insurance (Medicare or Medicaid) and 31 percent have no health insurance. Combined, around 80 percent of the county’s population are represented.
Effective approaches to prevent and control diabetes require a comprehensive approach of primary, secondary and tertiary prevention. The ACC leverages the resources and expertise of a wide range of organizations, including the major health systems and healthcare providers, local public health district, employers, the Chamber of Commerce, universities, housing groups, public parks and city planners, transportation groups, economic developers and planners, a range of faith-based organizations and many others.
Strong, consistent medical care that is affordable and/or covered is vital to managing or preventing diabetes. In addition, daily self-management and maintaining a healthy diet and higher levels of physical activity are necessary to help those with diabetes improve their health and prevent others from developing diabetes in the first place. Some of the activities and initiatives promoted by the ACC, in addition to those directly related to education and care for disease, have included community gardens, fresh food preparation, exercise and others.
Specifically, the ACC has worked on the following initiatives: (1) expansion of the concept of “public lands for public health” with the Cuyahoga Valley National Park; (2) a regional health impact assessment of the Akron Marathon; (3) partnerships with the faith-based community and the University of Akron for health education and increasing screenings for individuals who are underserved including refugees, Native-Americans, the homeless, and those in low-income housing; and (4) work with the Akron Metropolitan Transportation System to transform some of the local roadways into “Complete Streets”.
In addition, the collaborative recognized that knowledge and information management is essential to understanding and analyzing health and cost patterns. This led the ACC to develop systems for confidential sharing of patient data using an integrated data platform, which allows healthcare entities to track health trends and cost savings. Participating hospitals and providers receive a share of the healthcare cost savings achieved by the program, and other funds are reinvested in the ACC or other community efforts.
The initiative also received a Community Transformation Grant (CTG), which was created by the Affordable Care Act, from the Centers for Disease Control and Prevention (CDC) to help support their activities. CTGs are awarded to communities that are taking integrated, evidence-based approaches to preventing disease.
In just over two years, the initiative has already seen positive results:
- The average cost per month of care for individuals with diabetes was reduced by more than 10 percent per month;
- After one year of involvement, consistent reductions in healthcare costs are in excess of 25 percent with estimated program savings of $3,185 per person per year;
- Decline in emergency department visits because of diabetes: a drop from nine to six emergency room visits for people in the higher glycated hemoglobin ranges (HbA1c>8%); and a drop from six to three visits for people in the lower glycated hemoglobin ranges (HbA1c<8%);
- More than half of participants lost weight and reduced waist size;
- Lowered cost per person per contact hour with healthcare providers ($25 vs. $37.50 for other leading diabetes prevention programs);
- Better management leading to decrease in glycated hemoglobin (A1C) (a measure of diabetes) and LCL cholesterol (often known as “bad” cholesterol) levels;
- No amputations because of diabetes;
- Increase in reported exercise and flexibility;
- Significantly fewer days in which reported mental and physical health was not good;
- Improved self-rated health; and
- Improvement in knowledge surrounding healthier dietary choices, health behaviors and diabetes self-management.
The ACC has been successful in improving quality of care, lowering the cost of care, delaying the progression of disease, expanding the population receiving comprehensive care, reducing the overall burden of disease in the community, and increasing productivity. The initiative is planning to expand to focus on additional health problems, such as obesity, hypertension and asthma. Akron is a healthier place with lower healthcare costs because of the ACC, and it is more attractive to businesses and other groups because of its more vibrant and productive workforce.
For more information on the Akron Accountable Care Community, see:
 ABIA is a unique biomedical innovation institute, founded in 2008 by Akron Children’s Hospital, Akron General Health System, Northeast Ohio Medical University, Summa Health System, The University of Akron and the John S. and James L. Knight Foundation. The City of Akron and the County of Summit are key participants in the initiative.
 For a definition of “Complete Streets” see: http://www.smartgrowthamerica.org/complete-streets/complete-streets-fundamentals