Minding the Gap

HMOs and PPOs and MCOs and ACOs and ACCs, oh my. It seems that our health care system is an alphabet soup of acronyms. However, these acronyms represent more than abbreviations for areas of care; they tell a tale of health system evolution.

As we look at the progression, we notice that one item is unlike the others: ACCs—Accountable Care Communities. HMOs, PPOs, MCOs, and ACOs are all part of the evolution of our health care systems based on tweaking clinical care and payment models to achieve various aims such as reduced costs, improved quality, and better health. Where ACCs tread new ground is recognizing that clinical care alone cannot improve health and reduce costs. Too many of the factors that influence health are not within the realm of the traditional health care delivery system. ACCs are an innovative model to address the gap that health providers have long known existed between clinical care and the environmental factors that heavily influence health outcomes.

The ACC model recognizes that the communities in which we all live, learn, work, and age actively shape our health. While doctors and health systems are increasingly being held responsible for health outcomes, most factors influencing health outcomes—housing, transportation, education, poverty, access to healthy foods, public safety, and social supports—are not within the scope of clinical care. As a result, we have seen that when health care systems attempt to improve health through clinical care alone, health and cost outcomes often do not improve significantly. ACCs attempt to bridge this gap by formally integrating clinical care and community services. In ACCs, health care delivery systems collaborate with community service providers and others to address a broader range of factors influencing health. Partners in an ACC align their programs, services, and workforce to meet the shared goal of improving the health and well-being of those they serve.

This issue of the NCMJ explores the opportunities of accountable care communities for the state of North Carolina. Articles define the concept, explain the creation, and provide examples of how these communities are already beginning to take shape in our state. Overall, this issue goes beyond a routine citation of the aspirational merits of the Quadruple Aim (quality, cost, client satisfaction, and provider satisfaction), by demonstrating how it can be achieved through community partnership.

• ©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.