Title: ACO
1ACOs A 10,000 Foot View
2A Key Driver of ReformLong-term Federal Debt
3Origins of the ACO Model
4Current Medicare ACO Model
- Based on staff model HMOs
- Greater medical staff
- Move towards risk-bearing
- Compete with other ACOs
5The Plan Competing ACOs
Lourdes ACO
Cooper ACO
Virtua ACO
6The Unique Challenges Were Facing in Camden
7Camden 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
8Additional 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
9A Different ACO Model for Camden
10A Different ACO Model for Camden
- Hospitals
- Primary care providers
- Behavioral health providers
- Patients
- Social service agencies
- Public health organizations
- Housing providers
11Differing ACO Visions
12A Camden ACO Vision.
- The City of Camden will be the first city in the
country to dramatically improve healthcare and
reduce costs through collaboration.
13Building Blocks for a Camden ACO
- High Utilizer Teams
- Primary Care Medical Homes
- Target High Cost Buildings
- Open Access Scheduling Panelizing Practices
14Disruptive Change- Patient Centered Medical Home
Geisinger Demo- 18 reduction hospitalization,
36 reduction in 30 day readmissions
15Patient Centered Medical Home
Current Model
New Model
16Patient 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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18The ACO Life Cycle
- Certification
- Establish organizational capacity
- Gainsharing Plan
- Present implementation plan
- Prove financial and clinical readiness
- Engage the public
- Annual Review
- Demonstrate effectiveness
19Certification
- 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
20The 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
21NJs 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