In an effort to survive and thrive in the transition to value-based payment models, New Jersey’s Hackensack University Medical Center launched an experiment, which, so far, looks promising.
“I think we’re not trying to boil the ocean,” said Robert Glenning, executive vice president and CFO of HUMC, during a session at the Healthcare Financial Management Association’s annual ANI conference this week. “We’ve got some very, very clear goals and we understand that those goals aren’t really the complete picture…But if we go with trying to boil the ocean kind of strategy, than nothing of substance is going to come.”
Part of HUMC’s experiment into transitioning to value-based models has been to set up Hackensack Alliance ACO.
The key to making the transformation, said Glenning and his co-presenter, Cynthia Ambres, MD, a partner at KPMG’s Global Healthcare Center of Excellence, is clinical integration.
“You’re not going to get anywhere without" physician buy-in, said Ambres.
To achieve clinical integration, they said, organizations need to move from episodic care to population management by developing and cultivating infrastructure at all levels of care delivery, managing transitions of care across all sites of service and between clinicians, and adopting clinical treatment protocols.
Launched in April 2012, Hackensack Alliance ACO features a select group of primary care physicians contracting through the Medicare Shared Savings Program. Practices are certified as patient-centered medical homes and are committed to adopting electronic health records. Nurse care managers coordinate care.
The ACO has decreased costs by reducing unnecessary care, identifying and eliminating barriers to care, improving patient adherence to treatment plans, and reducing admissions.
The next steps, Glenning said, are to move physicians toward bundled payments and to evolve a co-branded Medicare Advantage plan.
HUMC believes bundled payments will engage a larger community of providers, are vital to developing a population management infrastructure, and align financial incentives among providers. Its bundled payment program covers a broad range of procedures across a number of specialties, and targets reductions in three areas: acute care readmissions, unnecessary admissions to skilled nursing facilities and length-of-stay at skilled nursing facilities.
The organization has just begun creating a co-branded Medicare Advantage plan, Glenning said. HUMC seeks to partner with an existing insurance plan that has demonstrated MA success and will share financial risk and competencies that will support staff engagement and allow for continued infrastructure growth.