The idea of an accountable care organization (ACO)—a coordinated group of providers rewarded for achieving good outcomes for a population of patients while cutting costs—predates the Affordable Care Act (ACA). Private health plans and medical groups have long experimented with the concept—and since 2004, the federal government itself has run Medicare demonstration projects. But the ACA’s reliance on the idea to help slow the growth in Medicare spending has put ACOs on the map.
To date, four New Jersey programs have been approved by Washington, according to the New Jersey Hospital Association: the Atlantic Health System ACO, the Hackensack Physician-Hospital Alliance ACO, the Optimus Healthcare Partners ACO, and AtlantiCare Health Solutions.
Different in some respects, they share a common operating model. Each ACO must serve at least 5,000 Medicare beneficiaries. If an ACO saves Medicare money, it can keep some of those savings for itself if it has done well by its patients—which it must prove by reporting its results in 33 different measures of quality.
Off the ground since April, the Atlantic ACO, for instance, is a partnership of Morristown-based Atlantic Health System and Valley Health System in Ridgewood. Included in this partnership are roughly 1,300 physicians drawn from the two systems—250 primary-care doctors, and the rest specialists.
Physician collaboration will be key as ACOs go forward. Linked electronically and with access to the best scientific evidence in their respective fields, doctors in and outside of the hospital setting are expected to coordinate their efforts in order to monitor and manage the often complex treatment of elderly patients. The goal: to keep each as healthy as he or she can be.
But will beneficiaries (who can opt out) buy into the concept? “The notion that someone is going to be managing my mother’s care is almost hysterical to me,” says Amy Mansue, president and CEO of Children’s Specialized Hospital. “She’s a pretty strong-willed woman used to managing her own care.”
Goldstein anticipates pushback, particularly from the oldest beneficiaries, but he’s cautiously optimistic.
“It all depends on how well we get across the idea that we want to take better care of you, and that your doctor is helping us do that.”