ACO ’ s: A 10,000 Foot View

1. ACO’s: A 10,000 Foot View

2. A Key Driver of Reform:Long-term Federal Debt

3. Origins of the ACO Model

4. Current Medicare ACO Model • Based on staff model HMOs • Greater medical staff • Move towards risk-bearing • Compete with other ACOs

5. The Plan: Competing ACOs Lourdes ACO Cooper ACO Virtua ACO

6. “Where there is no vision, the people will perish” The Unique Challenges We’re Facing in Camden

7. 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

8. Additional challenge….

9. A Different ACO Model for Camden

10. A Different ACO Model for Camden • Hospitals • Primary care providers • Behavioral health providers • Patients • Social service agencies • Public health organizations • Housing providers

11. Differing ACO Visions Geographic attribution No risk Shared savings Open network Learning collaborative Community-based/Primary care focused Risk-bearing Capitation Medical staff attribution Closed network Insurance product/Mini HMO Hospital-centric

12. 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.

13. Building Blocks for a Camden ACO • High Utilizer Teams • Primary Care Medical Homes • Target High Cost Buildings • Open Access Scheduling & Panelizing Practices

14. Disruptive Change- Patient Centered Medical Home Geisinger Demo- 18% reduction hospitalization, 36% reduction in 30 day readmissions

15. Patient Centered Medical Home Current Model New Model Quality Improvement Care Coordination Patient Engagement Practice Management Acute Care

16. 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

18. 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

19. 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

20. 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

21. NJ’s 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