QI Collaborative: A Learning Network for Re-designing New Jersey’s Safety-net Health System

The  Medicaid  ACO  Demonstra4on  Project    

Jeff Brown

Execu4ve  Director  of  the  QI  Collabora4ve      

jbrown@njhcqi.org    

Agenda

•  Making  the  case  for  payment  reform  (the  problem)  •  New  Jersey’s  Medicaid  ACO  Demonstra7on  Project  (the  policy)  •  Limita7ons  (the  poli7cs)  •  Recommenda7ons    

 

Economies  our  health  care  system  is  bigger  than:    

For  all  that  money,  how  does  the  United  States  measure  up  when  it  comes  to  quality?  

Waste and Inefficiency

Productivity in US Health Care

1:22    

How Big is the Opportunity?

How Big is the Opportunity?

 •  $284  million  from  reduced  inpa4ent  high  user  costs    •  $155  million  in  lower  costs  from  avoidable  inpa4ent  stays  and  

emergency  department  visits      •  $94  million  from  reduced  readmission  costs      •  $70  million  from  reduced  emergency  department  high  user  costs    

The  cost  of  doing  nothing:  $603  million  per  year…at  least.  

Agenda

•  Making  the  case  for  payment  reform  (the  problem)  •  New  Jersey’s  Medicaid  ACO  Demonstra@on  Project  (the  

policy)  •  Limita7ons  (the  poli7cs)  •  Recommenda7ons    

 

Healthy Greater Newark ACO

Healthy Cumberland Initiative

Camden Coalition of Healthcare Providers

Trenton Health Team

Passaic County Comprehensive Care ACO

New Brunswick Health Partners

New Jersey’s Medicaid ACOs

Legal Requirements

1.  Non-profit corporation 2.  Board representative of health care interests, including

consumers 3.  100% hospital participation 4.  75% of “qualified primary care providers” 5.  4 behavioral health providers 6.  Gainsharing plan in year 1 7.  Accountable to a series of quality measures 8.  At least 5,000 Medicaid beneficiaries 9.  TCOC payment model – “total accountability”

Agenda

•  Making  the  case  for  payment  reform  (the  problem)  •  New  Jersey’s  Medicaid  ACO  Demonstra7on  Project  (the  policy)  •  Limita@ons  (the  poli@cs)  •  Recommenda7ons    

 

Limitations

1.  No direct state funding 2.  Optional participation by managed care plans

3.  100% hospital participation

4.  75% of “qualified primary care providers”

Keys to Success for New Jersey’s Medicaid ACOs

1.  Staffing/Operations/Start-Up Costs 2.  Sustainability/Contracting/Payment Models 3.  Care Coordination and development of

appropriate interventions 4.  HIT Infrastructure 5.  Quality Metrics 6.  Access to timely data via State and plans 7.  Practice Improvement/Provider Engagement 8.  Behavioral Health Integration

Keys to Success for New Jersey’s Medicaid ACOs

1.  Staffing/Operations/Start-Up Costs 2.  Sustainability/Contracting/Payment Models 3.  Care Coordination and development of

appropriate interventions 4.  HIT Infrastructure 5.  Quality Metrics 6.  Access to timely data via State and plans 7.  Practice Improvement/Provider Engagement 8.  Behavioral Health Integration

Agenda

•  Making  the  case  for  payment  reform  (the  problem)  •  New  Jersey’s  Medicaid  ACO  Demonstra7on  Project  (the  policy)  •  Limita7ons  (the  poli7cs)  •  Recommenda@ons    

 

Recommendations

•  Allow  for  flexibility  in  governance  and  par4cipa4on    •  Allow  for  flexibility  in  payment  models  •  Engage  providers,  payers,  and  consumers  in  design  •  Provide  direct  funding  and  a  clear  path  to  sustainability    •  Align  with  other  programs  

 

The End

Jeff  Brown  Execu4ve  Director  of  the  QI  Collabora4ve      

jbrown@njhcqi.org