The Medicare accountable care organization launched last year by physicians affiliated with the Hackensack University Health Network is now the first ACO in New Jersey to be accredited by the National Committee on Quality Assurance.
The NCQA recognizes medical organizations that deliver patient-centered care to improve quality while reducing costs.
In its first year, the Hackensack Physician Hospital Alliance ACO saved Medicare more than $10 million, and is one of only seven ACOs in the country to be recognized by NCQA, according to Dr. Morey Menacker, chief executive of the ACO.
The Affordable Care Act authorized the creation of ACOs, which allow health care providers to receive a portion of the savings they achieve for Medicare.
The ACO started with a small group of doctors who are required to adopt electronic medical records; it has moved toward becoming patient-centered medical homes, also a quality designation from NCQA.
"We wanted to create a firm infrastructure for managing patients through their illnesses as well as their health," Menacker said.
Menacker said the ACO "hired a consulting firm to go into every practice to train them to get certification as a PCMH."
And the ACO is lending money to practices that did not have electronic medical records so they could make the up-front investment; the federal government awards grants to practices to help defray the cost of EMRs, and the grants will enable the practices to repay the loans from the ACO.
The ACO contracted with a population health management company whose software gathers data from the electronic medical records, so physicians can monitor patient care.
"The physician will know if a diabetic hasn't seen a podiatrist in nine months, or hasn't seen their eye doctor," Menacker said. "It's a tickler reminder for the doctor when they see the patient to discuss various issues, rather than the doctor having to sit down and go through the entire chart."
It's good for the ACO, too.
"It allows us, on a global scale, to take a look at how various physician practices are caring for various diseases," Menacker said.
Menacker said most patients see their doctors briefly, several times a year – which isn't enough.
"That is not enough to have a patient really think about their health and think about compliance long term," he said.
So the ACO has hired nurse navigators and embedded them in the physician practices. Each nurse is responsible for 1,500 patients, with a special focus on the high-risk patients.
The goal is for the patient to feel comfortable picking up the phone and calling the nurse, who can "intervene before a crisis occurs and the patient ends up in the ER."
Among the ACO's innovations: several patients with heart failure and other chronic conditions received tablet computer preloaded with guidance on a healthy lifestyles and medication instructions, to help them avoid readmission to the hospital after they've been discharged.
Menacker said the ACO launched in April of 2012, and in its first year saved Medicare $10 million compared to what the agency expected to pay for the medical care of the initial 12,000 patients. The ACO currently has 100 primary care physicians and 600 specialists serving 14,000 Medicare patients.
The ACO will share in the savings that flow to Medicare.
"The majority of the money goes back to the individual doctors because they are the ones actually providing the care and making the changes," Menacker said.