Accountable Care in the Safety Net: A Case Study of the Cambridge Health Alliance

Abstract

Following passage of health care reform in Massachusetts, the Cambridge Health Alliance (CHA), a public safety-net health system, began to establish an accountable care organization in an effort to continue its mission and remain financially solvent. In examining how CHA undertook its delivery system transformation, this case study explores the organization's four major strategies: establishing patient-centered medical homes, entering alternative payment arrangements with managed care organizations, launching complex care management, and establishing a partnership with a tertiary care institution. Workforce education and culture change were also core principles. Within two years, CHA had already received National Committee for Quality Assurance patient-centered medical home recognition for six of its primary care sites, and quality metrics demonstrate improvements in these sites compared with others. Moreover, utilization in one managed care organization is trending downward. Challenges persist, however, due in part to fiscal pressures created by state health care reform. OVERVIEWThe Cambridge Health Alliance (CHA) is a public safety-net health system based in Cambridge, Mass. In 2006, after the state passed its health care reform law, CHA formed an accountable care organization (ACO) to continue its mission and remain financially solvent. An ACO is an integrated health care system made up of hospitals, physicians, and other providers who share the responsibility of caring for a population of patients. The goal is to provide high-quality, coordinated care and to reduce spending by eliminating unnecessary services, with providers potentially rewarded for meeting quality and cost benchmarks. Early ACO pilots have focused on commercial and Medicare beneficiaries; few have addressed the feasibility of implementing ACOs for Medicaid beneficiaries and other vulnerable populations. Safety-net providers, from public hospitals and health systems to community health centers, must transform the way they serve their patients and communities-and do so with fewer resources and more complex patients than traditional providers. 1 This case study-based on interviews with staff, document review, and financial analysis-examines the market, policy, and organizational factors that led CHA to undertake ACO transformation; highlights key strategies, areas ofTo learn more about new publications when they become available, visit the Fund' s website and register to receive email alerts.

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