Riverside Medical Group has undergone a massive expansion over the past six months as it seeks to embrace value-based care.
Dr. Omar Baker, Riverside’s co-president and director of performance improvement, said Riverside has nearly doubled the number of counties in which it operates to Camden, Middlesex and Burlington Counties since August while maintaining practices in Hudson, Bergen, Essex and Passaic Counties.
Baker, who served as the health care adviser on Gov. Phil Murphy’s transition team, said Riverside has formed a partnership with the New Jersey Innovation Institute to “aggregate its data to form an actionable change that we can communicate to our providers.”
He also recently became part of the Membership Council of both NJII and the New Jersey Health Quality Institute.
“We believe in the importance of all of their resources, and from learning from large, not-for-profit groups that do tremendous research,” said Baker. “The partnership with NJII is to look at health information exchanges and the better utilization of data through some of the state brands.”
The group has also expanded its number of health care providers from 160 to 205 and its overall staff from 800 to 1,186 over the past six months. It‘s also added 18 specialty practices, including an optometry unit, as well as a population health team of 10 staffers that will focus on patient wellness and preventative care.
Baker said the expansion is tied to Riverside’s move towards higher risk-based models – cornerstones of value-based health care systems. In partial and full-risk models, health care providers will take on some or all of the costs of care for patients, while engaging in a shared savings arrangement with an insurer in which the insurer will give the provider an annual rebate if the provider is able to control costs through value-based care.
“What we’re planning in 2018 is to take on more risk,” Baker said. “We’re looking at partial risk models and some full risk models. As we get closer to that, we know that we’re prepared because we’re looking at the data on the cost per patient, whether it’s a Medicaid patient or a commercially insured patient. So we’re just looking at the best model that will currently be accepted by our organization, and one that will be mutually beneficial to Riverside, the insurance company, and most importantly, to the patients that we serve.”
The keys to providing value-based care, he added, are to have all of Riverside’s doctors buy into the system and to have efficient infrastructure in place to properly aggregate data and easily share health records among in-network doctors.
“What we’ve done is for value-based care is, No. 1, have a culture that is focused always on quality-driven care,” said Baker. “That starts with the personnel. It starts with the training, it starts with education of the providers, the team members, our nurse navigators and our care coordinators.”
Baker also touted the group’s shared electronic medical records system, which helps its doctors to coordinate patient care without duplication of services
“No. 2, we’re objectively measuring outcomes,” Baker said. “We have a population health team of about 10 people that we’ve recently added that basically looks at raw claims data and compares it to our clinical claims data. Most importantly we’re all on one shared EMR system, so it’s much easier when you have 80 sites with primary care givers, and now 18 specialty service lines. All of those providers are on one shared system, so that allows for real measurement of data, good communication and avoiding duplication of services.”
He added the group had 650,000 outpatient visits in 2017, and this year, and is on track to exceed 1 million because of its expansion and added infrastructure.
“We’re bolstering our adult primary care network because that’s where we can have the biggest impact on cost savings,” he said. “So what we’re doing is working with the big payers to review that data.”
Baker added that Riverside is also educating its doctors on risk-adjustment factors to help them provide high quality care in a cost-efficient manner, as well as monitor and work on ways the group can help cut down on emergency room admissions, in-patient admissions and readmission rates.
One of the most important additions in the last six months, he said, is the launch of Riverside’s wellness programs and a new specialist referral system.
“We launched wellness programs with a team of eight nurses,” Baker said. “We’re committed to making sure every single one of our patients get their wellness checks. And when any patient needs to see a specialist, we don’t just hand them referrals. The appointment is made at the point of care with the primary care doctor. All of our doctors are in network, including our specialists, and our policy is to get them an appointment within 72 hours. This will cut visits to out-of-network physicians and unnecessary ER visits.”
Baker said that when he served as co-chair of the Health Advisory Committee for Murphy’s transition team, he was impressed by the governor’s eagerness and willingness to learn from the committee’s 17-page list of recommendations to improve health care in the state.
“I was honored and humbled to serve as co-chair,” Baker said. “His team was so responsive to the recommendations that I am confident that they will act on the recommendations.”
Those widely publicized recommendations included developing a plan within 100 days to extend health coverage to New Jersey’s 70,000 uninsured children within four years, especially given that half of those children are not legal immigrants; returning the Division of Mental Health and Addiction Services from the Department of Health to the Department of Human Services; studying and recommending changes to the 21-year-old welfare reform law; and distributing $20 million in the budget intended to raise the pay of people from community agencies who work with children and people with developmental disabilities.
“The thing that the administration and all people are looking at is that health care is regional,” Baker said. “We have to look at it county by county, and we have to look at demographics and disparities in care. We have to try to understand why does Camden have one of the highest pediatric asthma rates in the country? Why does Newark have one of the highest child obesity rates? Why is vaccine compliance lower in this region of the state versus other regions? What can we do to help those specific regions that have specific issues?”