By Janine Janosky, Vice President, Head, Center for Community Health Improvement, Austen BioInnovation Institute in Akron
The Austen BioInnovation Institute in Akron (ABIA) is a collaboration of Akron Children’s
Hospital, Akron General Health System, Northeastern Ohio Medical University, Summa Health System, The University of Akron and The John S. and James L. Knight Foundation. Not surprisingly, this partnership mirrors the Akron and Summit county communities, as healthcare and education are the region’s largest economic sectors.
Our region is also home to a vital community, with an extensive park system that includes biking, hiking and running trails, cross-country skiing, lakes and much more.
However, in the Akron Metropolitan Statistical Area (MSA), which encompasses Summit County, 10.8 percent of the population has been diagnosed with diabetes, with an additional 2.1 percent reporting pre-diabetes or borderline diabetes as a diagnosis.
This compares to a rate of 10.1 percent for the state of Ohio and 8.3 percent for the United States.
With regard to diabetes-related risk factors in the Akron MSA, 24.8 percent of the population reports no physical activity in the past month; and 77.7 percent of adults consume less than the recommended five servings of fruits and vegetables per day. In addition, 37.3 percent of adults are overweight, and 30.4 percent are obese.
Clearly, The Akron MSA represents an at-risk community that would benefit from health interventions.
In response to the region’s and nation’s need for a collaborative and shared approach to community health, about 18 months ago, ABIA’s Center for Community Health Improvement began the effort to usher in a new health culture in the Akron region by developing an Accountable Care Community (ACC), a new health model which aims to foster collaborations borne of shared responsibility among various sectors to transform health in Northeast Ohio.
The ACC is a collaborative, integrated, and measurable strategy that focuses on health promotion and disease prevention, access to quality services, and healthcare delivery. As such, the ACC is not dependent upon healthcare systems adopting specific public or private payer initiatives. Rather, it builds on initiatives to encompass not only the area’s medical care providers, but also the public health system and community stakeholders whose work, taken together, spans the spectrum of the determinants of health. In addition, the ACC focuses on health outcomes of the entire population of a defined geographic region, i.e., Summit County, OH instead of silos of populations of health consumers selected by a health insurance entity or provider participant.
When we developed the ACC, it was important to fundamentally change health and health care delivery from silos to a more integrated and coordinated system that utilizes existing resources in the community, for example: concepts such as patient-centered medical home, care coordination, shared accountability, collective impact, and value-based payment.
Specifically, the ACC model is structured around the following components:
(1) Development of integrated medical and public health models that deliver clinical care in tandem with health promotion and disease prevention efforts;
(2) Utilization of interprofessional teams including, but not limited to, medicine, pharmacy, public health, nursing, social work, mental health, and nutrition to align care management and improve patient access and care coordination;
(3) Collaboration among health systems and public health, to enhance communication and planning efforts;
(4) Development of a robust health information technology infrastructure, to enable access to comprehensive, timely patient health information that facilitates the delivery of appropriate care and execution of effective care transitions across the continuum of providers;
(5) Implementation of an integrated and fully mineable surveillance and data warehouse functionality, to monitor and report systematically and longitudinally on the health status of the community, measuring change over time and assessing the impact of various intervention strategies;
(6) Development of a dissemination infrastructure to rapidly share best practices;
(7) Design and execution of a robust ACC implementation platform and impact measurement tool; and
(8) Policy analysis and advocacy to facilitate ACC success and sustainability.
Significant progress has been made within the initial 18 months of designing, developing, and implementing the ACC. After analyzing and evaluating the needs to improve population health, we identified diabetes as the initial priority. We focused on the spectrum of health promotion and diabetes prevention, diabetes self-management, secondary and tertiary prevention of diabetes complications, and the care and services of individuals currently living with diabetes.
ABIA was positioned as the hub for the development and execution of the ACC including series of targeted, multi-party interventions.
The first project encompassed a cohort of individuals with diabetes who were linked to care and services within the ACC. Available to each of the individuals, based upon their needs, was augmented medical care, programs and initiatives for self-management, and secondary and tertiary prevention. These included diverse interventions such as education for self-care, nutrition, physical activity, mindfulness for social and emotional wellness, among many others.
After we linked these individuals with community resources, we found beneficial health outcomes and cost of care outcomes, showing improvements in biometrics e.g., reduction in weight and/or waist measurement, decline in blood sugar and increase in self-reported fitness levels. In addition, we have found an approximate 10 percent cost savings in the utilization of care for these individuals.
The second project focused on a diabetes self-management program that was an educational and experiential program in a small group setting with participants drawn from diverse practice sites. For this cohort, studied microscopically, over a six month period, we found that those individuals born before 1965 (baby boomers and older) were the most successful at decreasing their BMI, and lost an average of 2.166 points of BMI. For all individuals, overall, they showed a decrease in their Hemoglobin A1c (HbA1c) percentage by approximately 0.45, with no differences by age, generation, race, and limitations. This decrease showed their diabetes is better controlled and also led to an estimated savings of $3,185 per person, per year in medical costs. In addition, from the decrease in body weight, medical care costs, and losses from work, the cost of absenteeism decreased by $580 per person, year.
As a group, the number of emergency department visits was also lower during this period when compared to the six months prior. We have compared our findings to national findings, and the cost of our programs and our improved health and cost savings are well ahead of the norm. The analysis not only demonstrated the biometric successes of the program, but also reduced costs and improved overall individual community health. These data show that through an ACC positive outcomes along the Triple Aim (improving the individual experience of care, improving the health of populations, and reducing per capita costs of care for populations, according to Health Affairs) can be achieved.
As we move forward, with the support of the ABIA partners and an expanding network of community stakeholders, the ACC will enable Akron and Summit County, Ohio to become a guiding force for better health across all portions of our society.
In February, 2012, we released an ACC White Paper (available at http://www.abiakron.org/Data/Sites/1/pdf/accwhitepaper12012v5final.pdf), which has received more than 50,000 hits to the website, with over 15,000 downloads, and approximately 200 direct contacts. These direct contacts are inquires referencing working with health systems, universities, public health entities, local governments, and so forth to develop and implement an ACC in their communities. Quite simply, our ACC model of shared responsibility can be implemented and adapted for other communities throughout the nation.
Other communities around the U.S have implemented smaller initiatives around community-based approach to care with promising results.
Some examples include the Sagadahoc (Maine) Health Improvement Project, the Community Care of North Carolina Program and the Aligning Forces for Quality (AF4Q). These examples of integrated, community-based health improvement efforts have both informed and accelerated the ACC initiative to impact.
Access a PDF of this story here.