Is there still a role for academic medical centers in Accountable Care era?

The Accountable Care Act (ACA) creates two different pressures for academic medical centers, which by their nature provide mostly tertiary and quartenary care. One is a supporting pressure, as few admissions to academic medical center could be performed less expensively in other settings, and the other is a downward pressure as the shared savings model seeks to drive down costs even for the most advanced care.

The ACA seeks to eliminate avoidable hospitalizations. Since academic medical centers provide the highest acuity of care, most of their admissions are complex and would not be able to be done in less resource intense environments. So as long as these centers remain true to their mission and do not try to supplement their high acuity patient mix with less intense care that could be done in a less expensive community hospital or in the community, then there platforms should remain unchallenged. Academic medical centers should create linkages with community hospitals and accountable care organizations who will be referring complex patients to them, and in turn should refer back to these community based organizations patients with less intensive care needs.

Core to the ACA is the shared savings model of reimbursement. Baseline cost data is established and creates a threshold for future performance after being trended forward for inflation and discounted slightly for the benefit of the payer. The premise is that the provider gains if they provide care at lower than the benchmark price, and loses if they provide care at higher than the benchmark price. The challenge for academic medical centers is that it is built into their DNA to always be looking for more technically advanced techniques, which tend to drive up the costs of care and create an imbalance to the loss side of the shared savings equation.

To survive in the accountable care era, academic medical centers need to remain true to their mission of only providing the most complex care and need to nourish strong relationships with accountable care organizations and payers. Under shared savings models, they must focus with laser intensity on making sure care is value based. Even if approaches become more technically advanced and grow in cost,there must be evidence based outcomes on reduction in overall cost of care through fewer complications, shorter recovery time, improved clinical outcomes. Only under this scenario will academic medical centers make it.