ABIA is a 501(c)(3) nonprofit established to coordinate activities among three independent health care systems and two universities in northeastern Ohio, explained Janine Janosky. By taking advantage of ACA provisions, ABIA has created an accountable care community (ACC), an extension of the accountable care organization (ACO) concept, but one that does not depend on providers’ adoption of a Medicare infrastructure. The Akron ACC, whose vision is to improve the health of the community through a collaborative, integrated, multi-institutional approach that emphasizes shared responsibility for the health of the community, includes the 5 core institutions and partners with public health and more than 65 additional social services and education entities, including the local faith community and Cuyahoga Valley National Park (ABIA, 2012). Doing good for the community, she explained, can mean taking risks and considering the community’s needs in tandem with those of the individual organization. “Some of these institutions and organizations are leveraging their resources for the good of the accountable care community, and some made decisions to sundown or to expand programs because that is what the community would benefit from,” said Janosky.

In addition to going beyond the Medicare-based structure, Janosky discussed how the ABIA-led ACC includes a large grassroots component that aims to give equal voice to all the constituents in the community, not just those who have a particular health insurance policy or belong to a specific health system. Key components of the ACC include integrated, collaborative medical and public health models; interprofessional medical teams; a robust health information technology infrastructure that standardizes data across the multiple electronic health records (EHRs); a community health surveillance and data warehouse; and a dissemination infrastructure to share best practices. This data-driven system also includes a data analysis team to measure the impact of the ACC on community-wide health and a group dedicated to policy analysis and advocacy.

Outlining the steps that ABIA took to create the ACC, Janosky explained that the system is based on the Healthy People 2020 framework of health promotion, disease prevention, improved access to care and services, and health care delivery. “All of the members of the ACC fall within one or more of these realms,” she said. The first step to build this system involved conducting a community-wide inventory of assets and resources and mapping it to the Centers for Disease Control and Prevention’s (CDC’s) Health Impact Pyramid (see Figure 3-1) (Frieden, 2010). ABIA then took each of the metrics of Healthy People 2020 and conducted

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