Accountable Care Organization’s Innovative Approach Gets Results

Andrew Kitchenman | December 9, 2013 | Health Care
Hackensack ACO is first in NJ to gain accreditation for taking steps to cut costs while still improving quality of care

Dr. Morey Menacker, president and CEO of Hackensack Alliance Accountable Care Organization
Accountable care organizations could be a vehicle for reducing the growth in healthcare costs while improving the quality of care, so the early success of a northern New Jersey ACO in achieving those goals is an encouraging sign.

HackensackAlliance Accountable Care Organization recently became the first such organization in the state to receive accreditation from the National Committee for Quality Assurance, the only national group that accredits ACOs.

The Alliance estimates that it saved roughly $10 million in treating 12,000 Medicare patients between April 2012 and April 2013.

The Alliance says it did that while also boosting the the quality of care by employing such techniques as providing some patients with tablet computers that remind them to take their medications.

ACOs are groups of healthcare providers that agree to be held accountable for the cost and quality of care they provide, generally by agreeing to have a portion of their payments depend on their performance.

HackensackAlliance was named a Medicare Shared Savings ACO, a program launched under the 2010 Affordable Care Act in which providers are paid more by the federal Centers for Medicare and Medicaid Services if they are able to keep costs down while meeting agreed-upon standards for providing quality care.

Dr. Morey Menacker, the ACO’s president and CEO. believes the accreditation demonstrates that HackensackAlliance is upholding its commitment to more coordinated care. He said other organizations have claimed ACO status without backing that up with results.

“The problem is that anyone can call themselves an ACO,” Menacker said. “Whether or not they’re doing anything differently is basically determined by A, the data they can supply, or B, the recognition that they get.”

NCQA is a Washington, D.C.,-based nonprofit that accredits both healthcare providers and insurance plans. It bases its ACO accreditation standards on an organization’s ability to achieve three goals: lower costs, high-quality care and positive patient experiences.

Menacker said HackensackAlliance, which is the seventh ACO in the country to be accredited by NCQA, sought accreditation because it’s a way of validating the work it has been doing.

“It’s not just an application that you fill out, it’s also providing evidence that the policies and procedures exist and are being utilized,” said Menacker, who has an internal medicine practice in Paramus.

Doctors affiliated with Hackensack University Medical Center formed the alliance. It started with only 40 doctors in order to ensure that each was fully committed to such changes as using technology to increase communication with other providers, Menacker said.

“When we decided to create our organization it was intentional that we started with a small number of physicians, because we wanted doctors who understood that changes needed to be added,” he said.: “This is a start in the ability of physicians to be able to manage patients on a day-to-day basis rather than on a intermittent-visit basis.”

The Alliance has since then been carefully adding doctors in reaching the current number of roughly 100 members, Menacker said.

“This isn’t a group that just getting together so that we can have drinks on Friday nights,” he said.

Registered nurse Noreen Hartnett, care coordinator for HackensackAlliance ACO
Registered nurse Noreen Hartnett, who serves as a care coordinator for the ACO, sees the organization as a way of bringing Hackensack University Medical Center’s standards out into the community, both in the offices of local providers and in patients’ homes.

“We’re trying to empower the patient to take better care of themselves,” particularly those with chronic conditions, Hartnett said. This includes teaching patients about how to eat well, how to monitor their symptoms, and how to reach out to care coordinators before a problem becomes a crisis.

“They know to call me first,” Hartnett said, “so I’m their little lifeline before they’re admitted and oftentimes we can fix” problems before an emergency-room trip.

An example of the new tools that the ACO is using is the 10 tablet computers that it has been providing to certain patients who frequently use emergency rooms due to their difficulty in managing chronic conditions.

Hartnett gives the tablet computers to patients who are interested in using them and who are both alert enough to use the tablets and have the dexterity to handle them. They receive notices through a web-based application about when to take their medications, eat their meals and monitor their weight, blood pressure and blood sugar levels. If a patient doesn’t log in that they’ve taken medication, or if a test comes back with troubling results, a notice is sent directly to Harnett’s cell phone.

She pointed to the case of a patient, 86-year-old Louis Ferreira of Fair Lawn, who has congestive heart failure and gained seven pounds in two days – a sure sign that he was retaining fluid. It turned out that he had eaten a meal at a family gathering that contained a higher level of salt than was appropriate, leading to the fluid retention that is a chronic problem for patients with congestive heart failure. Hartnett then was able to adjust his medication levels.

“In the past, he would have gone to the emergency room because he was so short of breath, but we were able to catch it before he became uncomfortable — we saved an admission” to the hospital, Hartnett said.

Ferreira said in a phone interview that he was grateful for the tablet, which provides hourly notices about which medication he should take.

“When the alarm goes off, you know your medicine is due,” said Ferreira, a retired bus driver.

Prior to receiving the device, “my wife was having a problem with (tracking medication), I was having a problem with it,” Ferreira said. “It’s the best thing we ever did – having this tablet.”

Ferreira said every patient in his position should have a similar device.

“I don’t think the older people should go without it,” he said.

Hartnett cited another example of a patient who took a trip to Hawaii and brought their tablet computer– allowing the care coordinator to track the patient’s symptoms (which were fine) throughout the trip.

HackensackAlliance’s progress is receiving notice elsewhere in the state.

Jeff Brown, executive director of the Affiliated Accountable Care Organizations, credited the ACO with seeking the accreditation, since it requires collecting data covering a wide variety of measures related to both clinical quality and cost. The AACO is an initiative of the nonprofit New Jersey Health Care Quality Institute. It aims to help develop ACOs to treat Medicaid patients.

Brown, who recently became the AACO executive director, said these ACOs could look to HackensackAlliance for inspiration.

He added that its affiliation with Hackensack University Medical Center is a strength for the Alliance.

“Hopefully other organizations can learn from Hackensack – and follow in their footsteps,” Brown said.

He added that he was impressed with the use of tablet computers to aid patients.

“That’s an example of an intervention that could be effective and it’s an intervention of how technology and data are allowing us to expand the things we could do and give a level of accountability and help to needier patients we couldn’t have done before,” Brown said.

NCQA Assistant Director Catherine Leape, who oversees accreditation programs for the organization, said the process demonstrates to both public and private payers, as well as employer groups, that an organization is meeting the standards set by an outside organization for improving health outcomes, reducing costs and improving the patient experience.

HackensackAlliance achieved the first of three levels of accreditation. This status will last two years, at which time it plans to apply for a higher-level accreditation. The different levels reflect the amount of evidence that an organization has compiled that show that it is meeting its goals.

“It definitely sets a high bar and it is the gold standard for demonstrating the capabilities of the ACO,” Leape said.