Transcript ACO Steering Committee Monday, June 6, 2011

Leading Transformation
The Commonwealth Fund
March 14, 2013
Steven Blumberg
Senior Vice President and Executive Director
AltantiCare Health Solutions
Who We Are
• Southeastern New Jersey’s largest health system and largest noncasino employer
• Dedicated to building healthy communities
• 5,000+ team members in over 70 locations
Vision:
AtlantiCare builds healthy communities
Mission:
We deliver health and healing to all people
Though trusting relationships
Values:
Safety, teamwork, integrity, respect and
service are our values
AtlantiCare Service Area
Primary Service area:
252,000 pop.
Regional Service area:
440,000 pop.
60 miles from Philadelphia
market
75% local market share
16% outmigration in PSA
Atlantic City
Building Partnerships &
Establishing Relationships
• Current Partners
– AtlantiCare Engaged Benefit
– Medicare Advantage
– MSSP effective Jan 1st 2013
• Prospects
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Local large employers – Casinos
Commercial payors
Unions
Municipalities
Special Care Center
Chronic care management focused on high-cost,
high-utilization patients. Our objective is to improve
quality of life, return patients to productivity, and
reduce overall cost of care.
Operational for six years with 2,700 patients
enrolled during that period. Most local large
employers participate on a PMPM basis for
primary care services.
The SCC Model
Patient-Centered Medical Home for high-risk
populations with multiple chronic conditions
The Special Care Center (SCC) model includes multiple
features to help reduce outcome disparities:
• Culturally and linguistically matched physicians and
health coaches
• In-depth and culturally appropriate educational materials
• Improved access
• Team training on cultural competency
SCC Downstream Costs
• Medications: switching to lower cost alternatives
• Testing: reducing unnecessary tests and using lower
cost settings when needed
• Specialists: finding and steering patients to high-quality,
efficient alternatives (or creating them if they don’t exist)
• Emergency Room: getting patients to call and getting
notified if they do get to ER
• Hospital: better management to keep people out,
aggressively managing LOS, consults, and testing
SCC Barrier Reduction
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Personal health coach for each patient
Waive visit co-pays and prescription co-pays
Open Access scheduling
Same day/next day hospital discharge
appointments
• Access to the care team 24 hours a day, 7 days
a week
• EMR utilization with visit planning
Utilization Measures
+43%
-22%
Office
Visits
ED
Visits
-23%
Admissions
Source: Milstein Fund Report, 2010 and Internal analysis
-8%
-15%
Length
of Stay
Average
Cost/Day
Exporting Success
• Hardwiring lessons learned from the Special Care
Center
• Primary Care Network Development – Primary
Care Plus (employed & affiliated)
• Development of high-value specialist network
• Incentive value-based contracting with providers
and suppliers
• Physician leadership development
Current Priorities
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Continuum-wide models of care
Integrated care and case management
Transitions of care programs
Integrated enterprise-wide technology platform
Medical home deployment
Analytics development
Thank You!