Rutgers’ New Medical School Affiliate Aims to Put Theory Into Practice

Andrew Kitchenman | October 15, 2013 | Health Care
Merger with UMDNJ spawns initiative to coordinate research with new approach to healthcare delivery

Dr. Alfred Tallia, who will be executive director of the new Robert Wood Johnson Partners ACO.
One of the first groups to benefit from the merger of most of the University of Medicine and Dentistry of New Jersey into Rutgers University could prove to be central New Jersey Medicare recipients.

That’s because a group of Robert Wood Johnson Medical School-affiliated healthcare providers is aiming to bring the Rutgers faculty’s research knowledge to bear in providing healthcare to Medicare patients as part of a new accountable care organization (ACO).

While these organizations have been growing rapidly in New Jersey over the past three years, the Robert Wood Johnson initiative will feature an unprecedented level of integration with the state’s research university.

ACOs are intended to change the way health services are delivered by emphasizing coordination of care. This is accomplished by changing how doctors and other providers are paid – moving toward a system where instead of receiving a fee for each service provided, they receive a set amount for caring for an entire population of patients.

The Robert Wood Johnson Partners ACO is a partnership of Rutgers and Robert Wood Johnson University Hospital and Health System. The providers will come from Robert Wood Johnson Medical Group, the family practice affiliated with Robert Wood Johnson Medical School in New Brunswick, which joined Rutgers as part of the UMDNJ merger.

Dr. Brian L. Strom, incoming chancellor of Rutgers Biomedical and Health Sciences, said the ACO offers a unique chance for Rutgers researchers to play a direct role in the changes affecting healthcare delivery. Rutgers Biomedical and Health Sciences includes the UMDNJ schools and programs that are now part of Rutgers, as well as existing Rutgers health-science programs.

“The beauty of the ACO is that it begins to address the underlying problems in our healthcare system,” said Strom.

ACO providers are given have targets for improving quality and lowering medical costs. Under the Medicare ACO program created by the 2010 Affordable Care Act, if an ACO saves money, those savings are split between the federal government and the providers.

Dr. Alfred Tallia said the new ACO is one of the first fruits of the Rutgers-UMDNJ merger. Tallia, the medical school family medicine and community health chairman, will be the ACO’s executive director.

“I like to think of this as the first big win from the merger,” Tallia said.

He said university faculty expertise in researching the health of an entire population group – such as older people — will be a key strength of the ACO.

The ACO plans to launch in January, but it’s not clear whether approval needed from the federal Centers for Medicare and Medicaid Services (CMS) will be delayed as a result of the partial federal government shutdown.

The ACO plans to expand later into agreements with private insurers and Medicaid to provide care to their patients. Tallia said the organization hasn’t set a timetable for applying to be a Medicaid ACO. A state Medicaid ACO pilot program is expected to launch early next year.

“Our hope is that as we expand to other insurers within the state of New Jersey that we can actually includes incentives for patients as part of the shared savings, which would be fairly unique and innovative,” Tallia said, citing cash incentives paid by New Jersey Manufacturers Insurance Company as a possible model.

New Jersey Manufacturers pays a dividend to its car insurance policyholders if the company performs well financially — in part due to drivers driving safely, which leads to fewer insurance claims. Tallia would like to have insured residents receive an incentive if the ACO saves money because members are taking better care of themselves.

Details of such incentives aren’t clear. Tallia also said he hopes that Rutgers research faculty members can help determine effective ways to motivate patients.

In addition to population health research, Tallia is hopeful that the ACO will help translate “bench” research done by biomedical and health science faculty members into care that benefits patients.

He said he also hopes that Rutgers-affiliated behavioral health specialists will participate in healthcare in the ACO’s primary-care practices.

“Quite frankly patients come packaged with both sides of the equation and problems together,” Tallia said of behavioral health and other healthcare problems, but the healthcare delivery system in the state has traditionally separated the care providers.

Strom also sees the ACO helping to serve the newly merged health science programs’ mission.

“You can’t very well teach people how to give care” without participating in the evolving world of care delivery, he said. He noted that both the ACA and insurance companies have been promoting shifts in delivery toward managing populations of patients, such as Medicare and Medicaid recipients.

“The future of medicine in the country is moving from a fee-for-service model that we have been doing to more of a population model and certainly Obamacare is pushing that, but private insurance is pushing it also,” Strom said.

While Robert Wood Johnson Partners will be unique in the degree to which a university is a partner in directly operating an ACO, it isn’t the first time in New Jersey that a university has helped increase care coordination. The Camden Coalition of Healthcare Providers – which is planning to become an ACO serving Medicaid patients – led by Dr. Jeffrey Brenner has worked with both Robert Wood Johnson Medical School and Rowan University’s Cooper Medical School.