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ACO

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ACO s: A 10,000 Foot View * A Key Driver of Reform: Long-term Federal Debt Origins of the ACO Model Current Medicare ACO Model Based on staff model HMOs Greater ... – PowerPoint PPT presentation

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Title: ACO


1
ACOs A 10,000 Foot View
2
A Key Driver of ReformLong-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
The Unique Challenges Were 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.
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
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
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
  1. High Utilizer Teams
  2. Primary Care Medical Homes
  3. Target High Cost Buildings
  4. 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
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

17
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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
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
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