ACO

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ACOs A 10,000 Foot View
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A Key Driver of ReformLong-term Federal Debt
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Origins of the ACO Model
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Current Medicare ACO Model

• Based on staff model HMOs
• Greater medical staff
• Move towards risk-bearing
• Compete with other ACOs

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The Plan Competing ACOs
Lourdes ACO
Cooper ACO
Virtua ACO
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The Unique Challenges Were Facing in Camden
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Camden challenges/opportunities

• 100 million per year in hospital/ER spending
• 50 of population uses an ER/hospital in 1 yr
• 1 dx for ER visits- head colds (12,000/5 yrs
• Costs highly concentrated
• 30 costs 1 of the patients
• 90 costs 20 of the patients
• Individual buildings
• Northgate 2- 12 million/5 yrs for 600 pts
• Abigail- 15 million/5 yrs for 300 pts

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Additional challenge.
Emergency Department High Utilizers Top 1 2007
Camden
Patients 386
Visits 5169
Visits/Patient 13.4
visiting more than one hospital 80.6

Trenton
Patients 504
Visits 7616
Visits/Patient 15.1
visiting more than one hospital 78.2

Newark
Patients 928
Visits 14367
Visits/Patient 15.5
visiting more than one hospital 71.1
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A Different ACO Model for Camden
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A Different ACO Model for Camden

• Hospitals
• Primary care providers
• Behavioral health providers
• Patients
• Social service agencies
• Public health organizations
• Housing providers

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Differing ACO Visions
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A Camden ACO Vision.

• The City of Camden will be the first city in the
  country to dramatically improve healthcare and
  reduce costs through collaboration.

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Building Blocks for a Camden ACO

1. High Utilizer Teams
2. Primary Care Medical Homes
3. Target High Cost Buildings
4. Open Access Scheduling Panelizing Practices

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Disruptive Change- Patient Centered Medical Home
Geisinger Demo- 18 reduction hospitalization,
36 reduction in 30 day readmissions
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Patient Centered Medical Home
Current Model
New Model
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Patient Centered Medical Home

• Daily hospital census
• New embedded staff
• Program assistant
• RN/LPN care coordinator
• Patient advocate
• AmeriCorp health coach
• Weekly in-office case conference
• Group visits, EHR, registries, specialty support,
  staff training

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The ACO Life Cycle

• Certification
• Establish organizational capacity
• Gainsharing Plan
• Present implementation plan
• Prove financial and clinical readiness
• Engage the public
• Annual Review
• Demonstrate effectiveness

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Certification

• Purpose
• Define coverage area
• Confirm governing structure
• Evidence provider support program commitment
• State Action
• Review application
• Written approval / denial
• Assist with reconsideration
• Make all documents available

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The Gainsharing Plan

• Purpose
• Explain implementation plan
• Provide opportunity for public input
• Explain use and distribution of savings
• Define patient safety and quality programs
• State action
• Review, analyze and verify the plan
• Written approval / denial
• Assist with reconsideration
• Manage amendments
• Make all documents available

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NJs ACO The Importance of Quality

• The NJ ACO law provides the opportunity to share
  savings
• In exchange, NJ ACOs have the responsibility to
  provide quality care
• Federal laws also require quality
• Protect patients ability to access medically
  necessary care
• Prevent providers from denying care to save money
• Important elements to protecting quality
• Meaningful ways for patients to provide feedback
• Consistent monitoring of care