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Health Care Innovation Zones: An ACO for AMCs?

Julie Schulz, MD, Consultant, Sg2, April 7, 2011

This article was originally published by Sg2 on March 15.

As we watch accountable care organization (ACO) fever rise—spiking again after the Centers for Medicare & Medicaid Services (CMS) announced it will be releasing a Notice of Proposed Rulemaking—academic medical centers (AMCs) are left wondering what their role will be in a coming “ACO era.” Healthcare innovation zones (HIZs) have gotten significantly less media attention than ACOs, but present a compelling model for AMCs to consider. HIZs are 1 of 20 pilot projects that will be managed by the Center for Medicare & Medicaid Innovation (CMI). HIZs are fundamentally ACOs with AMCs at their heart, combining the unique advanced care expertise, data research capabilities and physician training competencies of academic hospitals in partnerships with nonacademic organizations, including community providers and public and private payers.

House of Representatives Bill
Specifics about HIZs are sparse in the Patient Protection and Affordable Care Act (PPACA), and CMS has not yet released additional details. However, a House bill proposed in 2009 by US Representative Allyson Schwartz (D-PA) and developed with input from the Association of American Medical Colleges served as a template for HIZ language and provides hints as to how HIZs may be implemented. In the bill, an HIZ is defined as a partnership arrangement in which an AMC leads and coordinates care with other hospitals, primary care providers, outpatient care, recovery and rehabilitation facilities, public health, community services, and Medicare and private payers. In addition, the bill dictated that HIZs must:

  • Identify a specific geographical zone and estimate the size of the patient population that could be cared for within the HIZ.
  • Coordinate a group of clinical entities capable of providing inpatient, outpatient, post-acute and preventive care.
  • Engage community and clinical care leaders in designing the HIZ plan.
  • Leverage information technology (IT) to coordinate care across facilities and geography.
  • Collect and report quality data to continuously maintain or improve the quality of care.
  • Provide comprehensive services to at least 50% of the population in the HIZ.
  • Collect and submit data on changes to medical education that reflect changes in how health care is delivered.
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