Hackensack Alliance ACO is a partner with Hackensack University Medical Center. It currently has about 120 physicians in its program, approximately 10,000 Medicare patients, and about 30,000 commercially insured patients. Not all of these patients are contracted as ACO patients. However, the ACO policy is to treat all patients equally.
Morey Menacker, DO, president of the Hackensack Alliance ACO, said they've created a small group of primary care physicians who understand the need for comprehensive patient care. "It is necessary to eliminate duplication of services, unnecessary tests, and inappropriate hospitalizations," Menacker said. He emphasized the need for continuous monitoring of a patient's condition, and compliance with recommendations and medications.
The ACO accomplishes those aims by using patient care navigators, nurses who see patients in their homes, call them frequently, and develop a relationship with them. Physicians supervise the nurses and follow up in their office or in the hospital. Menacker said that the only way to manage such a system is with a comprehensive electronic health record, accessible by the navigator, the physician, and any consultant that the patient might require. The system needs to be seamless and integrated via a cloud-based health information exchange.
"We decided to take the ACO route once it was learned that a sea change was coming to healthcare reimbursement," said Menacker. "A decision was made to be part of the solution, the cutting edge. The alternative was to ignore the need for change and be told what to do in the future."
The current payment model at Hackensack varies. It includes a fee for service component, a shared savings component, and a-per-patient per month management component.
Care coordination is a major spoke in the ACO wheel, said Menacker. "Our plan is to identify the high-risk patient, and concentrate our attention on preventing complications and hospitalizations in this population. We are in the process of implementing a patient care software program which will integrate with our various EMRs and gather all the data for reporting." That would allow ACO personnel to analyze the effectiveness of its coordinators as well as physicians and continue to implement processes to streamline and improve care, said Menacker.