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Building Medicaid ACOs in New Jersey: A Demonstration Project

Explore the innovative project led by Dr. Jeffrey Brenner to establish Accountable Care Organizations in New Jersey's Medicaid system, focusing on cost-saving strategies and collaboration among healthcare providers. Learn about successful initiatives in Camden, Trenton, and Newark aimed at improving healthcare delivery for Medicaid recipients. For more information, visit www.camdenhealth.org or contact jeff@camdenhealth.org.

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Building Medicaid ACOs in New Jersey: A Demonstration Project

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  1. A Demonstration Project to Build Medicaid Accountable Care Organizations (ACO’s) in New JerseyJeffrey Brenner, MDExecutive Director/Medical Director

  2. Long-term Federal Debt

  3. Dartmouth Atlas #1 Inpatient and Part B spending per decedent during last 2 years of life Source: Dartmouth Atlas of Healthcare. 2006.

  4. Camden Health Data • 2002 – 2009 with Lourdes, Cooper, Virtua data • 480,000 records with 98,000 patients • 50 % population use ER/hospital in one year • Leading ED/hospital utilizers citywide • 324 visits in 5 years • 113 visits in 1 year • Total revenue to hospitals for Camden residents $460,000,000 + charity care • Most expensive patient $3.5 million • 30% costs = 1% patients • 80% costs = 13% patients • 90% costs = 20% patients

  5. Top 10 ER Diagnosis 2002-2007 (317,791 visits)

  6. Northgate I public housing

  7. Overview of the Coalition • 20 member board, incorporated non-profit • Foundation and hospital support • Projects- • Camden Health Database • Citywide Care Management Project • Camden Diabetes Collaborative • Camden Health Information Exchange • Citywide Violence Intervention

  8. Comparing Emergency Room High Utilizers in Camden, Trenton, and Newark

  9. Community-based Accountable Care Organization NJ Medicaid Medicaid HMOs Behavioral Health Hospitals Primary Care Medical Home Social Service Providers Patient Specialists

  10. NJ Medicaid ACO Pilots • Community-based non-profit • Geographic Collaboration • 100% inpatient hospitals • 75% of primary care providers • At least 4 behavioral health providers • Payer participation • Mandatory Medicaid FFS • Optional Medicaid HMO’s

  11. NJ Medicaid ACO Pilots • Gainsharing or shared savings model • No change in current mode of payment • State plays the role of intermediary • Recognizing ACO’s • Ensures appropriate use of gainsharing funds • Rutgers State Center for Health Policy • Helps calculate gainsharing payments • Three cities ready (Camden, Trenton, Newark)

  12. ACO Pilot

  13. Camden cost savings strategies • Nurse practitioner led clinics in high cost buildings (at least 5 total) • Additional high utilizer outreach teams (at least 5 total) • Embedded nurse care manager (12 primary care offices) • More same day appointments (open access scheduling)

  14. More Information www.camdenhealth.org www.camconnect.org jeff@camdenhealth.org

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