NJ Medicaid Coalitions To Try Improving Public Health with Accountable Care Organizations

Source: NJ Spotlight
This week signaled a landmark as three groups that include a number of hospitals were selected to launch Medicaid accountable care organizations (ACOs), designed to improve coordination of healthcare for people with complex and chronic health conditions.
The long-awaited announcement of the groups’ selection culminated a nearly four-year process. The organizations selected are the Camden Coalition of Healthcare Providers, the Healthy Greater Newark ACO (building on the work of the nonprofit Greater Newark Healthcare Coalition), and the Trenton Health Team.
Dr. Jeffrey Brenner, executive director of the Camden Coalition, said the project, which will last for the next three years, offers an opportunity to adjust healthcare spending to better address the social factors that affect people’s health. For example, better care coordination can lead to more effective treatment of mental-health issues which, if left untreated, get results in more hospital visits.

The ACOs’ task is a tall order: improving the health of entire populations of neighborhoods with a high concentration of Medicaid recipients. They will stress care coordination, in which nurses work with patients to ensure that they’re receiving the appropriate treatments.

The healthcare that Medicaid ACO members receive can come from a wide range of providers, including primary-care providers and hospital-based specialists. Ultimately, the goal is to reduce the number of unnecessary hospital emergency visits and inpatient stays, as patients receive more consistent care outside of hospitals.
The ACO Demonstration Project has two major components. The first involves information sharing, in which the state Medicaid program and the different hospitals share data with the ACO to ensure that providers have up-to-date information about their patients. For example, a patient’s primary-care doctor might receive a message as soon as a patient arrives at a hospital. The second component is for providers and the ACOs to share any savings that result from their work.
There’s still work to do to complete the second piece of the project — the shared savings, which will require some of the insurers that currently manage care for Medicaid recipients to agree to the savings.

The applicants had to meet rigorous standards, including having every hospital, 75 percent of primary-care providers, and at least four mental-health providers in their service areas agree to participate in the ACO.

The state has hired the Rutgers Center for State Health Policy to track spending and patient outcomes. The criteria will include tracking whether there are fewer hospitalizations, whether immunizations increase, and whether more residents undergo preventative screenings.
If the initiative’s successful, policy experts expect Medicaid ACO-style projects to launch elsewhere in the state, and for the state to consider providing funding upfront for ACOs, rather than having them rely on shared savings realized after they provide care.

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