Update on ACO Operations and Care Management Strategies in the New Jersey Medicaid ACO Demonstration Project

DeLia D, Yedidia M, Lontok O
Publication Year: 2018
Patient Need Addressed: Care Coordination/Management
Population Focus: Medicaid beneficiaries
Intervention Type: Service redesign
Study Design: Other Study Design
Type of Literature: Grey
link: http://www.cshp.rutgers.edu/Downloads/11400.pdf
Abstract

The New Jersey Medicaid Accountable Care Organization (ACO) Demonstration was implemented over a three-year period beginning on July 1, 2015 and recently, a one-year extension of the Demonstration was recently authorized. Previously published reports provided quantitative and qualitative information about activities leading up to and in the first year of the Demonstration. This report provides a detailed assessment of ACO activities in Demonstration year 2. It relies on the second round of interviews with leadership and care coordination staff from NJ’s three certified Medicaid ACOs and the Medicaid ACO-like group, the Health Coalition of Passaic County (HCPC). The study team performed a content analysis of the interviews and developed core themes and perspectives, which are outlined below. As in the first round, the content analysis emphasized a search for common themes across the ACOs. Although some commonality was evident, this latest round of interviews produced more information about ACO-specific activities, accomplishments, and plans for the near future. Three overarching themes that emerged from the interviews are listed below:

  • Theme 1: Access to comprehensive Medicaid claims and encounter data is the most important resource made available to ACOs by the state.
  • Theme 2: ACOs serve as conveners and connectors to build upon, enhance, and initiate healthcare delivery changes in their local service areas.
  • Theme 3: ACOs are using startup funds (state and private) to leverage other grant revenue, which is the main source of funding for the foreseeable future. Prospects for shared savings have been deemphasized
    • Insights Results

    Lessons learned

  • Access to comprehensive Medicaid claims and encounter data is the most important resource made available to accountable care organizations (ACOs) by the state
  • ACOs serve as conveners and connectors to build upon, enhance, and initiate healthcare delivery changes in their local service areas
  • ACOs are using startup funds (state and private) to leverage other grant revenue, which is the main source of funding for the foreseeable future. Prospects for shared savings have been deemphasized
    Successes
  • Incorporated home visits from community health workers (CHWs) and health coaching and mentoring with patients through a contract with Inquisitive Health
  • Increased reimbursement to 7-Day Pledge practices for comprehensively managing 5-patient panel of complicated patients using ACO-specified tools
  • A new data integration effort that includes information from county jail, schools, and
    housing authority records
  • The ACO has made progress in building partners’ interest in the program. In doing so, they have seen an increase in enthusiasm among hospitals in working with community partners
    Challenges
  • Lack of access to this data source is by far the most important drawback of not being certified for participation in the demonstration
  • Care management initiatives are often viewed as the distinct province of individual healthcare systems and that Healthy Greater Newark (HGN) activities may be viewed as extraneous to, or in competition with, those of large providers such as Robert Wood Johnson/St. Barnabus. These dynamics have made it difficult for the ACO to gain attention and commitment from key providers in their service area
  • Limited funding and lack of a clear path for future funding are major barriers
    • NEW SEARCH