Hospitals, health systems and physician organizations have taken the lead in catalyzing over 750 accountable care organizations since the passage of the Affordable Care Act in 2010. ACOs are charged with being accountable for both the cost and quality of care for a defined group of patients. Under risk-based, value-based payment models that reward achieving cost and outcomes of care, provider organizations have incentives to keep people well. While early evidence on ACOs is somewhat mixed, it seems sufficiently encouraging to fuel continued growth.

A major lesson to date is that delivery system provider organizations cannot do it themselves. To effectively work with high-cost, highly complex, chronically ill patients requires outreach to an array of community and social services resources including education, housing, transportation and public health, among others. This exposure to cross-sector organizations that can help manage illness is also generating a larger vision of improving health for the population at large — the population beyond a delivery system’s current patients, enrollees or service area. To constrain the rate of growth in costs, and improve population health and patient experience, will require the creation of accountable communities for health (ACHs), also called accountable care communities.

Accountable communities for health are cross-sector organizations that come together to form a governance body or “integrator” entity with the skills and resources to accept responsibility for allocating resources to maintain and improve the health of an entire identified population of community residents. ACHs emphasize the role played by the social determinants of health. They may initially focus, for example, on lowering the incidence of new cases of diabetes in the population or reducing the percentage of children and adults who are obese. Potential funding sources come not only from existing payers and providers — through community benefit requirements, for example — but also from local foundations and social investors to create “wellness funds.”

What can hospital and health systems do to spread ACHs? (1) Use their resources and influence to highlight the importance of building communities in which all people can lead healthy, productive lives. (2) Eliminate the considerable waste still existing in medical care delivery to free up resources that can be redeployed to upstream activities that address underlying behavioral, environmental and social determinants of health. (3) Use financial capital to increase the community’s social capital through the development of effective partnerships with public health, education, housing, transportation and related organizations that influence the community’s health. (4) Use electronic health record and data analysis capabilities to promote linkages with other sectors’ data and create a dashboard to track progress on population health indicators. (5) Support implementation of all-payer claims databases to raise the transparency of data and information so all parties are aware of opportunities to improve performance. (6) Promote and participate in national initiatives to improve population health, such as the Robert Wood Johnson Foundation’s “Culture of Health” undertaking.

In the business world, value (and job security) is provided by satisfying the customer. The customer is changing from the sick patient to the healthy individual within the context of a community that supports health and well-being. No longer will value (or job security) be provided by primarily “fixing up” people. Increasingly, value (and job security) will be provided by working with others to keep people well. In most communities, hospital and health system leadership will be key to achieving this vision for a healthier and more productive country. 

Stephen M. Shortell, PhD, MPH, MBA, is Blue Cross of California Distinguished Professor of Health Policy and Management, director of the Center for Healthcare Organizational and Innovation Research at the University of California–Berkeley. He is the 2015 recipient of the TRUST Award from the Health Research & Educational Trust. Visit

News from the AHA

AHA, AMA offer 6 principles for integrated leadership

The AHA and American Medical Association in June released new guidance on best practices for reimagining traditional relationships between physicians and hospital executives. The six principles provide a framework for physicians and hospitals that choose to create an integrated leadership structure but are unsure how to best achieve the engagement and alignment necessary to collaboratively prioritize patient care and resource management.

NCHL to present Umbdenstock with Leadership Excellence Award

The National Center for Healthcare Leadership will present its 2015 Gail L. Warden Leadership Excellence Award to AHA President and CEO Rich Umbdenstock. “From his position as the head of the AHA, Rich Umbdenstock has shown unparalleled leadership in breaking through the divisive debate on health reform to help drive change and improvement in the nation’s health care system,” NCHL President and Board Chair Tim Rice said. “His leadership and innovative thinking span all aspects of the health care system.” The award will be presented Nov. 17 in Chicago. Umbdenstock will retire from AHA at the end of this year.

HRET, University of Kentucky to study care transitions

The AHA’s Health Research & Educational Trust will partner with the University of Kentucky Center for Health Services Research on a study to determine transitional care services that improve health outcomes and are of high value to patients and their caregivers. The study, called Project ACHIEVE — Achieving Patient-Centered Care and Optimized Health In Care Transitions by Evaluating the Value of Evidence — is funded by the Patient-Centered Outcomes Research Institute. The three-year project will involve the design and development of best-practice recommendations and emphasize the importance of patient transitions from hospital to home as well as the evaluation of nursing facilities and community care transitions.