Last year, New Jersey adopted legislation that lets approved nonprofit groups test a new way to care for Medicaid patients.
State officials and health advocates are still working out the regulations to make the first Medicaid Accountable Care Organization demonstration project a reality, but one of the biggest boosters is on the road explaining the core elements of the new approach.
An Accountable Care Organization, or ACO, brings together health providers across a community — including hospitals, clinics and behavioral health groups — to accept responsibility for a defined population of patients.
“The basic premise is, if we save money in Camden, if we get our act together and learn how to play nice, and actually reduce costs for the state, for Medicaid, that the state will share some of those savings back with us,” Dr. Jeffrey Brenner told officials during the National Governors Association meeting this month.
Brenner is a physician at Cooper University Hospital and executive director of the Camden Coalition of Healthcare Providers. Having spent most of his career tending to patients who get their care through the Medicaid program, he says taxpayers aren’t getting their money’s worth.
Brenner’s group spent years compiling billing information for the hospitals and emergency rooms in Camden. He says the data show a health system that often provides costly “disorganized” treatment in acute care settings such as emergency rooms and hospitals, instead of coordinated care in primary-care doctors’ offices.
Brenner’s research shows that a head cold was the No. 1 reason for visits to emergency rooms in Camden over one five-year period. Hospitals can charge $500 to $800 for those visits.
Brenner said the promise of an ACO is to deliver health care differently, get better results and rein in care costs.
An ACO would provide communitywide training on some of the proven care practices, such as same-day scheduling at the doctor’s office; more clinics lead by nurse practitioners; and providing “boots on the ground” outreach and care management for patients with complex health conditions.
Using ER visits as a vital sign
One idea is to arm doctors with an easy-to-read chart that maps out a patient’s hospital admissions and emergency room visits.
“A lot of docs will see a patient in a room and have no idea how many times they’ve been to the ER in the last year,” Brenner said. “So we think, going forward we need to make hospital and ER use a vital sign.”
Knowing a patient is a frequent flier in the ER is key information, he said, just like blood pressure, height or weight.
The chart would be embedded in every patient’s medical chart.
“So you print something like that out, and maybe there’s a big gap where the patient didn’t go to the hospital,” Brenner said. “And you can ask the patient, ‘What kept you out of the hospital? Were you living with your sister? was that the point when you were able to fulfill your prescriptions?'”
The attached chart maps a year of emergency room visits and hospital admissions for an actual Camden patient who racked up the most health-care expenses in 2011.
The chart tallies visits to all three hospitals in Camden.
“That’s a lot of visits,” Brenner said. “It’s not a very good story. It’s not a patient for whom we, as a health system, are doing a good job for. We’re wasting a lot of money and the patient is not getting healthier.”
Editor’s note: Jeffrey Brenner is a member of the WHYY Health and Science Desk Resource Group, community members who offer expertise and insight on health care issues across the Delaware Valley region.