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ACO Development in New Jersey: One CMO's Learnings from First-Stage Efforts

September 3, 2013
by Mark Hagland
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Anthony Slonim, M.D. of Barnabas Health in New Jersey, has much to say regarding lessons learned in ACO development thus far

The West Orange-based Barnabas Health is the largest integrated health system in New Jersey, encompassing seven acute-care hospitals, two children’s hospitals, a freestanding behavioral health center, ambulatory care centers, geriatric centers, the state’s largest behavioral health network, and comprehensive homecare and hospice programs. In May, it signed a definitive agreement for Jersey City Medical Center in Jersey City to become a member of the health system, with completion of the transaction scheduled for this fall.

Barnabas Health has created two accountable care organizations (ACOs) and three ACO programs. Barnabas Health ACO North encompasses three acute-care hospitals and 400 physician partners, and currently serves about 10,000 Medicare beneficiary lives. The Central New Jersey ACO consists of three Barnabas Health hospitals, as well as the participation of CentraState medical Center, a non-Barnabas hospital. That ACO encompasses 200 doctors and serves about 20,000 Medicare lives. Both Barnabas Health ACO North and Central New Jersey ACO are Medicare Shared Savings Program (MSSP) ACOs (with the program being sponsored by the federal Centers for Medicare & Medicaid Services, or CMS), with Barnabas Health ACO North joining the MSSP in July 2012 and Central New Jersey ACO joining in January 2013. Barnabas Health also recently announced a relationship with Horizon Blue Cross and Blue Shield of New Jersey to create  Medicare Advantage program together.

What’s more, Barnabas Health ACO North’s collaboration in NJ-HITEC, the state’s regional extension center and a statewide health information exchange (HIE), has been so successful that it was cited by National Coordinator for Health IT Farzad Mostashari, M.D., in a statement he gave on July 17 to the U.S. Senate Finance Committee. The Piscataway, N.J.-based IGI Health has been providing software platforms for both the ACO and the REC. Recently, Anthony Slonim, M.D., vice president and chief medical officer at Barnabas Health, spoke with HCI Editor-in-Chief Mark Hagland regarding all these initiatives and the broad strategies and the implications for U.S. healthcare of these types of collaborations. Below are excerpts from that interview.

I understand that you’ve been exceptionally involved in IT implementations and initiatives as a CMO.

Yes; I’ve done 16 EHR [electronic health record] implementations in my career: eight each with Cerner and Epic [the Kansas City-based Cerner Corporation and the Verona, Wis.-based Epic Systems Corporation].

I did the design-and-build for Cerner for Children’s Hospital Medical Center, Washington, D.C.,  when I was there [2003-2005, 18-month implementation]; I then supervised the design-and-build at Carilion Clinic in Roanoke, doing an eight-hospital install using Epic, when I was CQO [chief quality officer] there in 2007-2009. And here, we’ve been on a journey for about two years, and I’ve been here about two-and-a-half years altogether; and we’ve just implemented our last ED. So we’re now live in six acute-care hospitals and a behavioral health center—EMR [electronic medical record], CPOE [computerized physician order entry], and EDs [emergency departments], using Cerner. And we’re also on a journey to use Cerner ambulatory among our employed physician practices. And at Barnabas Health, the CIO actually reports to me.

Anthony Slonim, M.D.

How many people does your CIO have in IT?

The IT division is system-wide, and we have over 200 employees. It’s the one department that’s system-wide, across all seven hospitals and the behavioral hospital.

What have been the biggest strategic learnings overall, around ACO development, to date?

You experience several key learnings as you start up an ACO. And I’ve often been quoted as saying, when you’ve seen one ACO, you’ve seen one ACO; they’re all structurally different. In the first year, we spent time hiring people, setting up committee structures, creating data linkages, and to make sure we had the appropriate structure for analytics. And ultimately, this leads into the IT discussion, because we decided that rather than building new infrastructures, we would find partners. So we decided to work with IGI to help us with connectivity, analytics, and other aspects. It’s a consulting company that works with us in depth, to help us advance our infrastructure, connectivity, and data warehouse structure. They’re a partner with us, as are NJ-HITEC, the HIE, and Advantis International, the IT staffing company, which helps to facilitate data analytics and integrity for multiple ACOs.

Once you get up and running, what are the biggest challenges in ACO operations in the first year or two?

Putting the infrastructure together, making sure we had seamless connectivity and communications, and making sure we had a portal infrastructure to make sure we could allow the providers to communicate with one another. And We had a major deliverable for CMS, to make sure we were submitting our performance reports on time.

Have you had any challenges around supporting quality measure reporting?