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How a N.J.-Based ACO Achieved Shared Savings So Quickly

February 26, 2014
by Rajiv Leventhal
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Physician leadership, care coordination the keys to success for one ACO

Healthcare organizations are in wait-and-see mode when it comes to accountable care organizations (ACOs), but for those who are willing and able, the opportunity is there.

One such organization who has taken advantage of this opportunity is the N.J.-based Hackensack Alliance ACO, which started in April 2012 and has saved Medicare at least $10 million through the end of 2013, it announced at HIMSS. 
But it wasn't always easy from the get-go, says Denise Patriaco, director of care coordination at the ACO. "When we started, we had independent providers and community providers. So we were not an integrated system, and everyone was on different electronic medical records (EMRs). "We had post-acute providers that we were  relying on to take care of our patients, but we really had no good means of communicating patient history and data with them. So we didn't know how we would do this at first, to be honest."
Patriaco says it was the ACO performance management software company, TEAM of Care, that anticipated the organization's needs. "At that time, you have to remember that everyone was new to accountable care—especially me," she says. "It comes down to care coordination, and they understood it better than I did at the time. Communicating with all the different parties was essential, and they figured that out," she says.
In partnership with the vendor, the Hackensack ACO implemented a team-based model to proactively manage care coordination. Today, the ACO provides hospital and community clinicians, care coordinators, and patients a coordinated and unified view of the patient's clinical, financial, and administrative data in real time.
In addition to the financial savings, Hackensack has been able to grow substantially, Patriaco says. In April 2012, it started with less than 12,000 Medicare fee-for-service patients. In January 2013, the beneficiaries went up to 20,000, and even more recently, the ACO took on its first commercial contract that doubled its size, says Patriaco. "We want to grow and get up to 100,000 patients, which I know is a lofty goal, but, but by the end of year we think we can get to 80,000. And you do that by taking on more quality physician groups and taking on more commercial contracts, as well as getting some more employee contracts,"  she says. 
According to Patriaco, success has been a result of two main factors. First, it was started with physician groups that were were already patient-centered medical home (PCMH)-certified and had EMRs they were fully utilizing. "Some were involved in commercial contracts as well, so in essence they were really running mini ACOs themselves" Patriaco says. 'If you put those groups together, you're bound to be successful. Second, she says, was recognizing the need to put plenty of resources into care coordination. "Putting your resources into  care coordination is the best thing you can do. That money you put in will come back to you."
In the beginning, these already established quality physician groups were the organizational leaders, continues Patriaco, adding, "they showed us the way to go." But as physician practices kept getting added on to the ACO, the chances increased that not all providers would be on board with the change in culture. To this end, Patriaco says she was able to embed care coordinators into the practice to work one-on-one with that practice. "This helped make them part of the culture," she says. You show small successes and how we have been able to win over most of our physicians, and it becomes less of a problem."
Another key, says Patriaco, is lowering your expectations for financial profit in the first year. "When our business model first came out, we didn't expect any money. If you concentrate on really taking care of your patients, you can use the first year to figure out how to decrease your ER visits and keep your patients out of the hospital. If you do that, you're on the right track," she says. 
And of course, technology plays a large role, Patriaco adds. "I don't think there is enough technology in healthcare. Other industries have taken advantage of what technology can offer, but our industry hasn't. How can we use technology to motivate and engage patients and caregivers for better care? That's the question," she says.
At the end of the day, Patriaco truly believes that ACOs are a step in the right direction, even if they don't necessarily become the future of medicine. And her advice for others is to share ideas and experiences, while looking at the leaders who have been successful. "People have really good ideas, and you need to start somewhere," she says. There is a Napoleon quote, 'Opportunity often comes in disguised in the form of misfortune, or temporary defeat.' And what has more misfortune than the current healthcare system? It's a really exciting time for those who are motivated, willing, and have the resources."