Back in 2014, Johns Hopkins Medicine created the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Accountable Care Organization (ACO), with the aim of increasing value and access for patients across Maryland.
The model intrigued DeWayne Oberlander, CEO of Columbia Medical Practice, whose 25 providers focus on primary care.
“We saw joining JMAP as a way of developing more robust clinical integration of care for our patients,” says Oberlander. “While the primary care physician plays a key role, we needed closer working relationships for access to specialty care, and for complex patients, access to Johns Hopkins and tertiary care.”
JMAP has delivered everything Oberlander hoped for, and more. Through its SUSDR program—SUSDR stands for specialty urgent same-day response—JMAP offers rapid access for enrollees to Johns Hopkins physicians in 24 specialties. Being part of the ACO also helped the practice get resources for Medicare patients such as health behavior specialists—social workers who support patients’ mental and behavioral health needs—and pharmacists to review patients’ medications and help find affordable options.
“What the ACO brought us is a structure within which we could review, develop and implement strategies to improve the quality of care for our patients,” Oberlander says, as well as resources to address larger population health challenges at the disease management level.
These highlight just a few of JMAP’s efforts to lead high-value care for its 39,000 beneficiaries. At the core is creating a medical “neighborhood” for its enrollees, with a primary care medical home as well as a broader network of participating specialists, hospitals and skilled nursing facilities.
The work has not gone unrecognized. JMAP received a quality score of 92.42 percent from the Centers for Medicare and Medicaid Services for 2016. Compared with the previous year, the ACO increased its primary care services by 4.5 percent, decreased hospital readmissions by 5 percent, decreased emergency department visits by 1.5 percent and decreased emergency department visits leading to hospitalization by 2 percent. They also came in a half-million dollars under their benchmark spend.
JMAP leaders strive to continually improve the program through annual strategic reviews and planning, says Executive Director Scott Berkowitz. Other high-value areas of focus include appropriateness for magnetic resonance and computed tomography imaging, in collaboration with the Johns Hopkins Health System’s high-value care efforts, and employing pharmacists to help identify potential areas of cost savings for injectable drugs for Medicare Part B recipients. Over 2,000 individuals have been enrolled in a care coordination program where nurse case managers help coordinate care for at-risk patients.
JMAP partnered with the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program, developed by Sarah Szanton from the Johns Hopkins University School of Nursing, to address the needs of older adults with physical disabilities. The ACO also is looking into further support for home-based primary care needs for older adults who are chronically ill, frail or cognitively disabled.
In all efforts, JMAP pulls together expertise from Johns Hopkins HealthCare, the Armstrong Institute for Patient Safety and Quality, the Office of Johns Hopkins Physicians and other organizations within JHM, in support of high-quality care for patients.
“JMAP has been successful in bringing together talented team members from across Johns Hopkins Medicine—along with our primary care partners from Columbia Medical Practice and Potomac Physician Associates—in support of improved care for our patients,” says Berkowitz. “Although there is important work still to be done, JMAP has provided a key foundation from which we can continue to optimize patient-centered care.”
