Coalitions Set Aside Competitive Rivalries to Try to Improve Public Health

Andrew Kitchenman | July 2, 2015 | Health Care
Three groups selected to be state’s first Medicaid ACOs designed to bolster preventive care among low-income urban residents

Dr. Jeffrey Brenner, executive director of the Camden Coalition.
Hospital rivalries can get be intense, so it’s significant when longtime New Jersey healthcare competitors agree to work together.

This week signaled a landmark of sorts for such unlikely collaborations, as three groups that include a number of hospitals were selected to launch Medicaid accountable care organizations.

ACOs are 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 to get the Medicaid ACO Demonstration Project underway, beginning when the law authorizing the program was enacted in August 2011.

Since then, state officials worked with the federal government and local groups to finalize the rules governing the organizations, and also determined which applicants were prepared to follow these rules.

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.

“Too often, we’re spending money in the wrong places,” Brenner said. “We often medicalize social problems in America, and we see that every day in Camden. And we also spend a tremendous amount on acute, hospital-based care, and not enough on community-based services.”

The ACOs’ task is a tall order: to improve 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.

Joan Randell, chief operating officer of the Nicholson Foundation, said the rest of the country is watching the project. Her foundation provided more than $10 million to lay the groundwork for the initiative.

“They will learn what works, modify or discard what doesn’t, and ultimately spread the improved model,” said Randell yesterday during a webinar marking the project’s launch.

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.

Trenton Health Team Executive Director Gregory Paulson said each ACO will be successful only if they truly understand the health needs of their communities. He said his organization has been working for 10 years – five years as a formally incorporated nonprofit – to prepare for this task.

To best serve residents, “We need to pool the resources that we have, we need to move beyond some competitive motivations, and really capitalize on the collaboration,” Paulson said.

The Newark coalition has identified infant health as one its areas of focus, according to Dr. Denise V. Rodgers, chairwoman of Healthy Greater Newark ACO.

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.

While the Camden Medicaid ACO has reached agreements with UnitedHealthcare Community Plan and Horizon NJ Health, neither of the other ACOs has reached agreements with any insurers. They are currently in talks with multiple insurers.

While eight groups originally applied to join the project, two – Coastal Healthcare Coalition Inc., covering Atlantic City and Ventnor, and the Healthy Gloucester Initiative Inc., covering Paulsboro, Woodbury and Woodbury Heights — dropped out during the application process.

The other three, which completed the process but were not selected, plan to continue with similar care-coordination work. They are Health Cumberland Initiative Inc., covering Bridgeton, Millville, Vineland and rural areas in Cumberland County; New Brunswick Health Partners, including New Brunswick and sections of Franklin Township; and Passaic County Comprehensive Accountable Care Organization Inc., including sections of Paterson.

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.

State Medicaid Director Valerie Harr said in a statement that the level of interest in the project, as well as the work put into building partnerships, was “staggering.”

“We see tremendous potential in the ability of these communities to coordinate care in a way that makes sense for their Medicaid residents and provider community,” she said. “We hope this is the tip of the iceberg and encourage other ACOs to continue to develop their model for future opportunities.”

Each of the ACOs will focus on narrowly defined geographic areas. While the Camden Coalition covers the entire city, the Healthy Greater Newark will only cover parts of the city’s Central, South, and East Wards, encompassing four ZIP Code areas

[related]A crucial part of the project will be measuring whether it’s been successful. 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.

The three Medicaid ACOs and three applicants that weren’t selected are part of an umbrella group which shares what they’ve learned, known as the QI Collaborative. The collaborative, a project of the New Jersey Health Care Quality Institute, hopes to add more community groups and expand the work being done through the ACOs, according to Linda Schwimmer, the institute’s vice president.

Assemblyman Louis D. Greenwald (D-Burlington and Camden) said the work that’s already been done by the groups chosen to be Medicaid ACOs has been one of the biggest achievements in the state over the past five years.

He added that when he sponsored the law along with Sen. Joseph F. Vitale (D-Middlesex), it was still not known whether the goals of the ACO could be achieved. But the work of the Camden Coalition and others has shown the potential for the project, he said.