How Does This Fit into the Provisions of the Affordable Care Act? The goals are aligned

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2 Background April 2012 The Federal Centers for Medicare and Medicaid Services (CMS) approved 3 NJ Accountable Care Organizations (ACOs) to participate in the Medicare Shared Savings Program Accountable Care Organization. The Atlantic ACO is one of these.

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4 How Does This Fit into the Provisions of the Affordable Care Act? The goals are aligned Prevention and wellness Reducing healthcare costs Increase quality

5 What is an ACO? An accountable care organization (ACO) is a group of physicians and other health care providers who voluntarily work together with Medicare and other payers to provide high quality service and care at the right time in the right setting.

6 What Does The ACO Mean? The physician s office staff works cooperatively with: ACO Inpatient Case Managers Complex Care Coordinators Home Care staff Nursing Homes Rehab Centers Hospice Community Agencies DMEs All treating providers (APN s and physicians) Pharmacy services.

7 What Does The ACO Mean? Utilize available technology to share patient information to facilitate high quality, cost effective care Encourage patients to become more knowledgeable about and active in their own care Actively participate in the sharing of information to reduce duplication of tests and services 7

8 Our Atlantic ACO Today 4 Hospitals / Regions (Morristown Medical Center, Newton Medical Center, Overlook Medical Center and The Valley Hospital) Servicing four (4) regions of northern New Jersey, primarily in Bergen, Essex, Morris, Sussex, Union/Somerset counties 1,300 Physicians (950 Specialists and 350 Primary Care) More than 50,000 Beneficiaries Profile of Providers 65% of Physicians eprescribe 48% of Physicians Use an EMR Valley ACO: 163 Specialists and 53 Primary Care (total 216) 15,000 Beneficiaries

9 Physician Office (PCP / Specialist) Hospital ACO Care Coordination Center (855) ACO 7171 ACO Physicians Centers of Excellence Home Care Complex Care Coordination Patient Acuity Level Lowest Highest

10 Primary Risk Factors On problem medications: anticoagulants, insulin, oral hypoglycemic agents, aspirin and plavix, digoxin, narcotics History of psychological issues: Hx of depression or other psy. dx, positive depression screening Polypharmacy: >7 routine meds Lack of adequate support system Potential need for palliative care: Would you not be surprised if this patient were to die in the next year? Does this patient have an advanced or progressive serious illness? Yes to either question Poor health literacy 10

11 Preventive Health Adult 1 Flu Shot 2 Pneumococcal Vaccine 3 Weight Screening and Follow Up 4 Tobacco Use Assessment and Intervention 5 Depression Screening 6 Colorectal Cancer Screening 7 Mammography Screening 8 Blood Pressure within 2 years At Risk Populations Diabetes 9 HbA1C < 8% 10 LDL < Blood Pressure < 140/90 12 Tobacco Non Use 13 Aspirin Use 14 HbA1C > 9% (poorly controlled) HTN 15 Blood Pressure Control Ischemic Vascular Disease 16 LDL < ASA or Another Antithrombotic Heart Failure 18 B Blocker for Systolic Dysfunction Coronary 11 Artery Disease 19 Drug Therapy for LDL Lowering 20 ACE/ARB 33 Quality Indicators for ACO Care Coordination/Patient Safety 21 All Condition Readmissions 22 COPD Admissions 23 CHF Admissions 24 PCPs who Qualify for EMR Incentive Med Reconcile after Inpatient 25 Discharge 26 Fall Screening Done CAHPS: Patient/Caregiver Experience 27 Timely Care: Appointments and Information 28 Doctor Communication 29 Patient's Rating of Doctor 30 Access to Specialists 31 Health Promotion and Education 32 Shared Decision Making 33 Health Status/Functional Status

12 Information Technology Clinical Data Integration 12

13 Centers of Excellence: Coordinated care provided by expert clinicians and physicians who adhere to national standards in order to optimize health outcomes for the at risk population. Quality indicators are tracked and maintained. Cardiac/Congestive Heart Failure Cardiac Valves Neurology (Stroke) Pulmonary Geriatrics Diabetes Behavioral Health Oncology Orthopedic (TJR)

14 ACO Website for Physicians, Office Staff & Beneficiaries