News Feature | March 10, 2014

Medicaid ACO Looks Promising

Source: Health IT Outcomes
Christine Kern

By Christine Kern, contributing writer

Medicaid ACO

Coalitions in New Jersey continue preparations as they await state rules allowing launch of new healthcare model

New Jersey Spotlight writes, “A new model for providing healthcare to low-income New Jerseyans has the potential to achieve some of the savings called for by Gov. Chris Christie, but healthcare leaders also say there are significant limits to what it can achieve.” The Medicaid ACO was highlighted at the recent "Accountable Care Organizations and Healthcare Delivery System Reform" conference on healthcare.

A Trenton Health Team press release stated that the conference explored ways primary healthcare providers, hospitals, and clinics are rising to meet the challenges of a costly and possibly outmoded healthcare delivery system using an ACO.

Since the law creating a demonstration project was enacted in New Jersey in 2011, ACOs have been under development. With the final state regulations allowing the project to move forward anticipated later this year, the planning for implementation is gathering momentum.  State officials have said there isn’t a timeline for publishing these rules.

This pilot project, like other ACOs such as the Medicare Shared Savings Program, rewards providers by granting them incentives to achieve cost efficiency while at the same time improving patients’ health. This program, however, unlike other programs, will include all patients in a particular geographical region.

Three existing organizations – Trenton Health Team, Camden Coalition of Healthcare Providers, and Greater Newark Healthcare Coalition – are teaming up to apply for the Medicaid ACO project in New Jersey. Trenton Health Team’s executive director, Dr. Ruth Perry, believes that ACOs help patients attain the tools they need to navigate the array of challenges that they face.

Although the final legislative pieces are not yet in place, the groups in Newark, Trenton, and Camden have already made progress, laying the groundwork for the ACO project. John Koehn, CEO of Amerigroup New Jersey, said the Medicaid ACO is a model worth trying and that he expects insurers to participate, although there are potential stumbling blocks. For example, some patients may never interact with ACO nurses, but if they contribute to lowered healthcare costs, the savings may be inaccurately attributed to the ACO. He also pointed out that the project doesn’t include a provision to punish the ACO if it fails to lower costs.

And of course, the project may not be replicable in every county across the state. Nevertheless, the coalition believes that ACOs are a great place to start. Frank Winter, regional partnership manager for the federal Centers for Medicare and Medicaid Services, emphasized the uniqueness of the project in New Jersey. He said it was an example of valuable experimentation in care delivery.

The federal government is trying to implement coordination between different programs that receive federal funding, and Winter added that the Medicaid ACOs will likely work closely with these programs. “When you’re working together, you’re going to see a lot better results,” Winter said, adding that he’s optimistic about the projects’ chances for success.

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