Things are moving forward quickly along several fronts at Atlantic Health System, the five-hospital based integrated health system based in Morristown, New Jersey. There, a broad-based strategic initiative that encompasses two separate accountable care organizations (ACOs) developed by the health system, is pushing the envelope on quality and efficiency along multiple dimensions.
Atlantic Health System has two active ACO organizations, the Atlantic Accountable Care Organization (AACO), and Optimus Healthcare Partners. Among other efforts, the leaders of AACO and Optimus have identified a set of quality measures for skilled nursing facilities to target, around such concerns as length of stay, reduced hospital readmissions, and cost reductions, and have been able to work with 61 SNFs to achieve advances in all three areas.
Meanwhile, Atlantic Health continues to evolve forward its two ACOs. And in that context, one of the senior executives in the organization who is helping to lead its accountable care strategic push is Poonam Alaigh, M.D. Dr. Alaigh is working with Atlantic Health System, with the title of corporate consultant (though she is an employee). She has a long and distinguished career in healthcare; most recently, she was the Commissioner of Health and Senior Services for the state of New Jersey, where she had responsibility for the operational oversight and management of the state’s Department of Health and Senior Services. Prior to that, she had been executive medical director at Horizon Blue Cross Blue Shield of New Jersey, and before that, she had been national medical director for GlaxoSmithKline. An internist, she continues to practice part-time at the New Jersey Veterans Administration at Lyons, and is an assistant professor in the Department of Family Practice at UMDNJ/Robert Wood Johnson University Medical Center. She spoke recently with HCI Editor-in-Chief Mark Hagland about the accountable care efforts at Atlantic Health System. Below are excerpts from that interview.
You’ve got a lot of activities going on. You’re also still practicing medicine?
Yes, I’m an internist. I’ve always kept my clinical practice, through all the different roles I’ve worked in. I’ve been seeing patients at the VA here in New Jersey, for the past ten years. I was one of the first hospitalists in the country in the 1990s. I’ve worked with different health plans, with pharmaceuticals. Then in 2010, Governor Christie asked me to join his team. And at the state level and now working in the private sector, I’ve been involved in different elements of healthcare reform. And in April 2012, we started an MSSP [Medicare Shared Savings Program] ACO, Atlantic ACO. Now it’s commercialized, too.
Poonam Alaigh, M.D.
It’s really been an interesting journey. We started with 45,000 Medicare members; now we have 100,000 Medicare members, and 350,000 altogether, including Optimus. Atlantic Health System had two ACOs. We brought the two ACOs together in the last two years, so we went from 45,000, only Medicare beneficiaries in April 2012, to 350,000 members, 100,000 of whom are Medicare, and 250,000 of whom are commercial.
Are they still operating under two different corporate brand names?
Yes, and actually, we’re still two ACOs, even as we’ve now brought them together under the same MSO [management services organization].
Has Atlantic ACO achieved shared savings under the MSSP? Any savings?
We have not achieved shared savings yet in Atlantic ACO. You can form ACOs for two reasons. One is for immediate gratification. We went as a system with 2,000 physicians, nearly 70,000 Medicare beneficiaries. We went into this to be a change agent. And any physician who wanted to participate could participate. We never set any criteria for participation. We just always said, if you want to be part of change and learn with us and have the intention of evolving with us as a system, then come join us. So we went into this to change healthcare. Meanwhile, the Optimus model was a provider-driven model. It’s achieved shared savings every year. But this was a highly selected group of physicians who had experience in pay for performance healthcare, and who had had experience in patient-centered medical homes—about 500 right now.
Have you wrapped your ACO work into the core organizing strategy for the Atlantic Health System organization?
Yes. This was a way for us to become more intimate with the physicians, aligning them, bringing them on board. And they could retain their independent practices. We wanted to offer them different kinds of alignment with physicians, and we approached this as a core strategy. This was their bridge for understanding what was happening around the shift from fee-for-service to value-based care. So we went into Atlantic ACO with a very different mindset and goal than with Optimus. We haven’t yet achieved shared savings, but we may this year.
What have you achieved so far?