Bill Would Remake ACOs as Health Hubs to Enhance Coordinated Care

Lilo H. Stainton | December 5, 2019 | Health Care
Shared ‘real-time’ databases of claims and clinical data would better enable communities to target services to needs of residents

A Medicaid program intended to improve care for New Jersey residents with complex health and social needs would get a statutory makeover under a new proposal. Although the current program applies to four urban areas, the proposed measure would enable officials to create additional regional collaborations.

The legislation, which is sponsored by Assemblyman Louis Greenwald (D-Camden) and scheduled for a committee hearing today, would establish regional health hubs to replace the existing Accountable Care Organization demonstration projects. These nonprofit-led initiatives seek to coordinate care among medical providers, insurance companies and social service organizations in Camden, Trenton and Newark. A similar initiative in Passaic County operates under a less formal charter.

Greenwald’s bill would transform these four initiatives into health hubs and allow state officials to create others. All hubs would be required to create and maintain shared databases with claims and clinical data, serve as conveners among health care stakeholders in their regions and assist state agencies seeking to establish local programs. These entities would also help the state more effectively respond to public health threats, the legislation notes.

Good for the state, and for patients

The measure posits that it is in the state’s best interest to create these regional networks to reduce health disparities and improve outcomes for Medicaid members. “Such nonprofit organizations have the capacity to become local innovation-engines that use real-time actionable data and diverse stakeholder input to develop and implement innovative models for the delivery of effective, person-centered care,” it reads.

As drafted, the bill requires hospitals and insurance companies to contribute data to the hub, something that took years for some ACOs to achieve without a statutory mandate. It also ensures these organizations have access to state data and funds.

Greenwald told NJ Spotlight that, given the success of these projects, it is vital that they continue — and that other regions have access to these benefits. “Just like the ACOs before them, these health hubs will aim to improve quality and access to healthcare through collaborative, innovative and cost-cutting methods,” Greenwald said. “Those methods include engaging local stakeholders to learn about their healthcare needs. They also include identifying patients who frequently visit the emergency room to implement preventative measures that improve their lives and cut down on the number of unnecessary visits.”

The proposal has strong support from ACO leaders and their allies, who have come to see the current law as a barrier to the success of their initiatives. They say the state’s 2011 ACO statute is overly focused on payment models, while the new legislation will allow them to have a broader regional impact and do more with the data they collect.

“We saw this as a way to move beyond the original legislation and properly frame what we’ve built in New Jersey as what we actually have been all along,” said Gregory Paulson, executive director of the Trenton Health Team, which leads the collaboration in that city. It also reflects lessons learned in other states, he said, including California and Oregon.

Putting a decade of expertise to work

The proposal especially benefits from expertise gained by the Garden State’s ACOs over the past decade, Paulson said. The four initiatives have developed a “deep, rich understanding of the nuances of our communities” through their work with local agencies, neighborhood groups and faith-based organizations, he noted, “and we are the structures that look at the systems working in that locality and can make it better.”

Kathleen Noonan, CEO of the Camden Coalition of Healthcare Providers, which oversees the ACO in that city, said her organization is very excited about the health hub bill and grateful to Greenwald for his leadership. The model builds on the success of existing ACO projects, she said, and “will focus on convening stakeholders and using data to improve health at the regional level.”

The ACO model was a feature of the 2010 federal Affordable Care Act designed to better coordinate care among patients with complex needs and help them avoid costly hospital visits. At the time, experts thought the model would result in health care savings that could be shared by the nonprofit organization and its partners, including doctors, hospitals and insurance companies.

But ACO leaders in New Jersey said this goal became obsolete as the state shifted more Medicaid patients into managed-care plans, in which insurance companies are paid a set fee and seek savings in-house. Instead, the four initiatives have been sustained with $3 million annually, a split of state and federal Medicaid dollars.

Coordinating care with communities

The work has also evolved, as some ACOs found they could have even broader impact in their communities by targeting patients who faced high health-care risks, but aren’t currently the highest users of medical care. For example, Camden sought to reduce maternal and infant mortality by helping women of childbearing age address chronic health conditions; Passaic County is helping patients manage asthma and other lung diseases to reduce hospitalizations.

This progression led the New Jersey Health Care Quality Institute to release a “roadmap for redesign” of the program in June, based in part on interviews with ACO leaders, state Medicaid officials and representatives from other communities interested in similar programs. Linda Schwimmer, HCQI’s president and CEO, said that while her group didn’t work on Greenwald’s legislation, the bill “aligns completely” with its proposal.

“One of the benefits of having these hubs in place is that they can quickly support the State on public health issues as they arise because the hubs are the trusted community connector to government, health care systems, and community based social services,” Schwimmer added.

The bill (A-5977), introduced last month, calls for the Department of Human Services, which oversees the 1.8 million-member Medicaid program, to create a regional health hub program. Hubs would be required to establish and maintain a shared database with health information that allows users to examine both population and patient-level trends and recommend interventions; convene quarterly regional stakeholder meetings; and provide data and other assistance to help state agencies design effective regional programs.

In addition, the measure requires hospitals to share certain data with their local health hubs on a “real-time basis” and “not less frequently than daily.” Managed-care organizations must also contribute data under the bill, along with relevant state agencies.

The bill also enables the DHS to work with the state Department of Health to designate new regional health hubs or expand existing programs based on available funding, the concentration of Medicaid members, hospital use and the need for coordination among health and social service organizations working in the area. These new hub areas must not overlap with core areas served by existing programs.