New Operating Models for Healthcare: I-Count
In June 2013, The Forbes Funds assembled 25 leading agency executives, representing a microcosm of Allegheny County’s primary care, behavioral health and human service providers. This community action team was asked to consider how Allegheny County could leverage the Affordable Care Act to build a stronger health care safety net that addressed both the quality and cost of health care for individuals who are high utilizers of the health care system. After extensive review of national care models and analysis of the local health care environment, the team designed I-Count, an Accountable Care Organization. It represents an integrated model of primary care, human services and behavioral health services. A robust planning process is underway. The key features of I-Count are:
- Individualized intensive care management focused on reducing emergency room use and readmissions
- Medical-social model with heavy emphasis on care management with continuous follow up
- Modeled to impact the top 5 percent of utilizers who generate 50% of health spending, but open to all
- Designed as neighborhood-based service unit and supported by a robust administrative hub
- Services provided by existing community based organizations with successful track records and capacity to assume risk
- Initial scaling will be three neighborhoods reaching 10,000-12,000 individuals in total
- Resultant shared savings with revenue enhancement for insurers
- Improved HEDIS, P4P and STARS scores will increase quality payouts
I-Count will establish three community-based service units supported by one administrative hub. Each unit will be comprised of primary care providers, a Federally Qualified Health Center and/or larger primary care practices, and approximately 15 social service agency clusters with expertise in population management. The intent is to achieve more efficient transition from acute care hospitals, focusing on reducing inappropriate admissions and readmissions and improving HEDIS and STARS preventive health delivery and scores for a chronically ill at-risk population in Allegheny County.
The Forbes Funds is facilitating the development of the model and planning process supported by area foundations. We believe this medical-social model will transform the delivery of services based on the strengths of community based organizations and partnerships with key healthcare institutions. We plan to spin the model out to be an independent organization in the early part of 2016.