NJ RHH/Medicaid ACO Demonstration Project

UPDATE: FY 2020 State Budget Replaces ACOs with Regional Health Hubs

Trenton Health Team applauds New Jersey leaders for designating and funding Regional Health Hubs in the FY 2020 state budget, enabling partnerships across the state to expand and enhance health care.

Regional Health Hubs are replacing state Medicaid Accountable Care Organizations to better serve residents receiving healthcare coverage through Medicaid — those who often lack access to the resources needed to be, and stay, healthy. New Jersey’s regional partnerships — THT, Camden Coalition of Healthcare Providers, Healthy Greater Newark, Health Coalition of Passaic County — integrate, coordinate, and align disconnected programs to improve patient care and outcomes, ultimately making communities healthier.

THT Executive Director Gregory Paulson in March shared testimony with the state General Assembly Budget Committee urging policymakers to designate existing ACOs and regional partnerships as “Regional Health Hubs” and to maintain funding in FY 2020.

This regional health approach was informed by THT participation in the ReThink Health Ventures program supported by The Rippel Foundation and Robert Wood Johnson Foundation. Ventures helped THT re-examine how to improve health & well-being in Trenton–focusing on both healthcare AND “upstream” issues such as nutrition, housing & economic opportunity See the Trenton Health Team Case Study

How ACOs Started

In August 2011, Governor Chris Christie signed into law NJ P.L. 2011, Chapter 114 requiring the NJ Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) to establish a three year Medicaid Accountable Care Organization (ACO) demonstration project. ACOs are designed to improve health outcomes, quality and access to care through regional collaboration, and shared accountability while reducing costs.

Trenton Health Team ACO recently announced grants totaling about $145,000 to seven community-based nonprofits helping Trenton residents address complex health concerns ranging from long-term effects of trauma to bed bugs. See projects

The Medicaid ACO demonstration project provides the New Jersey Medicaid program an opportunity to explore innovative system re-design including testing the ACO as an alternative to managed care; evaluating how care management and care coordination could be delivered to high risk, high cost utilizers; stretching the role of Medicaid beyond just medical services to integrate social services; and testing payment reform models including pay for performance metrics and incentives.

Efforts begun in 2011 under New Jersey’s Medicaid ACO Demonstration Project have evolved into four regional partnerships (Trenton, Camden, Newark and Paterson) that integrate, coordinate and align all those disconnected programs aimed at making communities healthier. Our focus is on residents who receive healthcare coverage through Medicaid–those who often lack access to the resources needed to be, and stay, healthy.

State support for such local, community-based innovation has been critical. We applaud the Legislature’s efforts to improve both delivery and quality of healthcare in New Jersey. In fact, New Jersey is rapidly becoming a national model for how communities can come together to tackle our shared health challenges. (See testimony to NJ Department of Human Services from THT Senior Director of Policy and Strategy  Emily Baggett)

Health Hubs provide a community-based structure for convening stakeholders, planning and providing health interventions. We maintain a regional view of our communities, while supporting the health of each individual in that community. Working as partners, we have formed a network focused on improving well-being throughout the state.

Building upon the Medicaid ACO structure, the proposed FY 20 state budget would formally recognize the first four Regional Health Hubs in New Jersey and continue the current $1.5 million appropriation. This budget would enable New Jersey to leverage a 1-for-1 federal funding match supporting efforts to streamline healthcare in participating communities and providing models for other regions across the state.

New Jersey ACOs are required to be nonprofit organizations serving a minimum of 5,000 Medicaid beneficiaries within a designated region. In addition, the ACO is required to contract with 100% of the hospitals, 75% of the primary care providers, and at least four mental health providers in the intended service region.

Trenton Health Team ACO

Trenton Health Team ACO (THT-ACO) was certified as one of the first Medicaid Accountable Care Organizations in NJ, serving the greater Trenton community. The ACO pilot is for a three-year period, effective July 1, 2015. An ACO is a healthcare model that has the three-part goal of

improving health outcomes, lowering healthcare cost, and improving the patient’s experience of receiving care. While the ACO model has been tested and found to be effective in achieving improved outcomes and reduced costs within Medicare, this adoption for Medicaid represents an important innovation in the design. Through this model, the THT-ACO is responsible for the health of all Medicaid beneficiaries residing in the six zip codes of Trenton: 08608, 08609, 08611, 08618, 08629, and 08638.

THT-ACO draws on the collaborative structure of THT, bringing together the vast majority of Trenton’s primary and specialty care providers through both of the city’s hospitals (Capital Health and St. Francis Medical Center), its only Federally Qualified Health Center (Henry J. Austin Health Center), and the City of Trenton itself, through its Department of Health and Human Services, in a shared effort to transform healthcare for the community. In addition, behavioral health providers, social service agencies, community organizations and city residents have joined in this community-wide endeavor to bring better healthcare at lower cost to Medicaid recipients within the Trenton geography.

“Trenton Health Team has been preparing for this initiative for several years, bringing together key community partners and developing the infrastructure and data capacity to manage the responsibility,” said James Brownlee, director of the Department of Health and Human Services and Health Officer for the City of Trenton, who also serves as THT’s vice president. “As a public health professional, I especially value the emphasis on health at the community level that is built into the project design, which will ultimately lead to improved health outcomes for our citizens.”

To improve the coordination of care and support the ACO project, THT established the Trenton Health information Exchange (HIE), a shared database that allows doctors and other providers to communicate directly about patient needs. This means less time is spent filling out paperwork and repeating one’s medical history to various providers. It also means fewer repeated medical tests or missed diagnoses.

“This recognition by the State is an important validation of our work to-date, establishing essential technological tools and building partnerships and trust across the range of medical and behavioral service providers,” said Trenton Health Team’s executive director, Gregory Paulson. “We believe the recognition as a Medicaid ACO will enhance our ability to serve the health needs of Trenton residents, providing a higher level of coordination and efficiency in the delivery of care, thereby improving outcomes for patients and containing costs for the healthcare system.”

“THT’s Medicaid ACO will achieve the goals of improving health outcomes and patient satisfaction while reducing costs through the strategic use of data and technology coupled with our continued and expanding community collaboration, which has defined our work for the past ten years,” said Paulson. “We are pleased to partner with the State in bringing this opportunity to the Trenton community.”

Frequently Asked Questions

What is the Trenton Health Team?

THT is unique in its public-private, community-wide collaborative structure, with all the city’s key healthcare providers actively engaged.  At the core of our organization is a distinctive collaboration among the City of Trenton’s public health department and the largest providers of healthcare services in the city, Capital Health, St. Francis Medical Center and Henry J. Austin Health Center.

The fact that city government, competing hospitals and the vast majority of primary care providers have come together and are finding common ground on behalf of the community is an extraordinary accomplishment that benefits the city’s residents.  To achieve our vision of making Trenton the healthiest city in the state, we also rely on the support of our partners in behavioral health, substance abuse, social services, faith-based groups, and other critical organizations throughout the community that support “good health” in the most holistic sense.

THT’s strategic initiatives include expanding access to primary care; improving care coordination and care management; establishing and operating a Health Information Exchange (HIE) to provide real-time access to shared patient data; engaging the community to increase knowledge and overcome obstacles to care; and building the infrastructure to become a certified Medicaid Accountable Care Organization (ACO). These initiatives serve to meet the Triple Aim of improved patient experience, better patient outcomes, and lower healthcare cost.

How are Trenton residents benefiting because of THT?

THT understands the need to listen and respond, and to work with the community to achieve results. Through our unified Community Health Needs Assessment, THT developed an understanding of the critical challenges impacting Trenton residents’ ability to be healthy.  We analyzed health data from multiple sources over the prior three years, but we also understand that looking at data can only tell us part of the story.  So, THT conducted 30 community forms and more than 300 individual interviews with Trenton residents to listen to members of the community about what affects their health on a personal level.

Our community assessment process allowed us to group Trenton’s health needs into five priority areas:  health literacy and disparities; safety and crime; obesity and healthy lifestyles; substance abuse and behavioral health; and chronic disease: diabetes, hypertension, and cancer.  In order to achieve good health, we understand that Trenton needs access to healthy food and activities in neighborhoods protected from crime and violence in addition to having access to good medical care to help treat and manage diseases.  We know that, as a community, we must address both medical and social needs to achieve our goal of better health at a lower cost.

THT can already point to significant accomplishments through our programs targeting these public health priorities.  For example, patients can now see their doctors more quickly after the adoption of a medical home model city-wide and an open access or “same day” scheduling system.  Our Community-wide Clinical Care Coordination Team, composed of physicians, case managers, nurses and social workers from our partners, was able to reduce emergency room use by more than 45% across the city.

Establishment of the Trenton Health Information Exchange, launched in January, 2014, gives doctors and nurses real-time access to a unified patient record that combines health data from hospitals, doctors and clinics across the community.  By having access to one comprehensive patient record, healthcare providers can better understand patients’ needs so they can help keep people healthy and out of the hospital while also reducing if not eliminating unnecessary repeated medical tests.

Trenton residents who have the highest health and social needs and who are in the hospital the most receive support from our Care Management Team, comprised of nurses, social workers and community health workers. They   meet with clients in the community and help them to develop and implement a personalized and coordinated care plan so they can take control of their own health and stay out of the hospital.

What will the ACO mean for Trenton residents?

Through certification as a Medicaid ACO, THT will build on its collaborative efforts and work to ensure that all residents within the six zip codes of Trenton receive coordinated healthcare that is based on the latest research and data analysis.  Increased awareness of healthy lifestyle choices coupled with increased access to and coordination of health care services will continue to move the city towards a culture of health.

THT’s Medicaid ACO will be responsible for all Medicaid recipients who live in Trenton.  This does not require changes to how they receive care or how they pick their doctors.  It does not mean changes to networks.  It does mean there will be accountability that includes specific quality and patient satisfaction monitoring.

The Trenton community will have a say in how cost savings will be reinvested.  We will develop a shared savings plan over the next year and will be scheduling open meetings for community members and organizations to help decide how that money is allocated.  It can be used to help make it easier for people to see their doctors, but it can also support health in other ways.  For example, the community will have an important voice in determining where and how educational opportunities and activities related to healthy lifestyles, such as our Faith in Prevention and chronic disease self-management programs are offered.  This may include community centers, churches, barber shops, corner stores, and other non-traditional settings.

Will the Medicaid ACO work?

ACOs have worked nationally: The ACO model has already been tested in the Medicare system. Since passage of the Affordable Care Act, more than 360 Medicare ACOs have been established, serving over 5.6 million citizens across the country.  In the first two years, Medicare ACOs generated over $417 million in savings for Medicare, while qualifying for shared savings payments of $460 million, according to the Centers for Medicaid and Medicare Services.

And THT has achieved results here in Trenton:  Increased access to care, shared access to real-time patient data, custom reporting functions through the Trenton HIE, improved care coordination, and reductions in avoidable emergency visits and inpatient stays are just a few of the accomplishments that are driving the triple aim that we seek through the Medicaid ACO structure.

Significant funding for the establishment of the THT-ACO infrastructure was provided through the generosity of: