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Building a Patient-Centered Accountable Care Organization (ACO) for Medicaid Beneficiaries

Wednesday, February 16, 2011
2:00 p.m. - 3:00 p.m. (Eastern)
1:00 p.m. - 2:00 p.m. (Central)
12:00 p.m. - 1:00 p.m. (Mountain)
11:00 a.m. - 12:00 p.m. (Pacific)


Jeffrey Brenner, MD
Executive Director/Medical Director, Camden Coalition of Healthcare Providers, Camden, NJ

Elizabeth Litten, Esq.
Partner, Fox Rothschild LLP, Princeton, NJ

Raymond Carter
Editor, Medical Home News (Moderator)


Few concepts have taken hold so fast as the Accountable Care Organization or ACO, the "new new thing." Most existing and potential ACO models being touted are in the Medicare and commercial health insurance sector, but this audioconference will argue that an ACO demonstration project focused exclusively on an underserved community with a high penetration of Medicaid would be easier to launch and more likely to succeed.

A broad coalition of stakeholders representing business, hospital, health care provider and consumer groups has joined together to propose the creation of Medicaid Accountable Care Organizations (ACOs) in the State of New Jersey. New legislation (S2443/A3636) was recently introduced in New Jersey to test the idea of a Medicaid ACO demonstration project. Aligned closely with the ACOs described in the federal Affordable Care Act, the legislation would create multi-stakeholder, geographic Medicaid ACOs.

The concept of Medicaid ACOs in New Jersey makes particular sense because the state has a very fragmented provider, hospital and payer marketplace. Medicaid patients are highly concentrated in urban, impoverished cities with a high percentage covered by government-sponsored health plans, making implementation of an all-payer ACO model easier. Also, reducing unnecessary ER and hospital use for complex Medicaid patients is less disruptive to the existing business model of New Jersey's hospitals and health care providers.

The proposed New Jersey law would authorize a three-year Medicaid ACO demonstration project whereby community-based, nonprofit coalitions can apply for recognition by the State of New Jersey as a Medicaid ACO. The applicants must propose a geographic focus and will need 100% of the acute care hospitals, 75% of the primary care providers, two behavioral health providers and two community residents from that geography on the board of the organization. The providers in the community will continue to receive their usual Medicaid payments. The ACO, if its providers meet quality benchmarks, would be eligible to receive shared savings payments that can be distributed to participants based on a proposed gain sharing plan.

ACOs involve complex legal issues, and the Legislature has declared its intent to exempt activities undertaken pursuant to the Medical ACO demonstration project that might otherwise be constrained by state antitrust laws and to provide immunity for such activities from federal antitrust laws through the state action immunity doctrine.

The groundwork has already been laid through the work of the Camden Coalition of Healthcare Providers (CCHP or the "Coalition"), a nonprofit organization committed to improving the quality, capacity and accessibility of the health care delivery system in Camden, New Jersey. Two similar citywide health care coalitions have been formed in Trenton and Newark. Coalition Executive Director Jeffrey Brenner, MD, will describe the proposed model and the preparation work ongoing in Camden to become a Medicaid ACO. Elizabeth Litten from the law firm of Fox Rothschild LLP will then explain some of the potentially tricky legal issues involved.

The Audioconference agenda is set forth in Eastern Daylight Time below:
2:00 pm Welcome, Introductions and Overview
Raymond Carter (Moderator)
2:05 pm Designing and Implementing an ACO for Medicaid Patients
Jeffrey Brenner, MD
2:30 pm Legal Issues
Elizabeth Litten, Esq.
2:45 pm Faculty Q&A
Raymond Carter (Moderator)
3:00 pm Audioconference Adjournment



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JULY 28, 2010
Outcomes and Lessons from a Primary Care - Health Plan Partnership - the New Jersey Academy of Family Physicians and Horizon BCBS New Jersey

Principal faculty:

Nicholas Bonvicino, MD, MBA
Senior Medical Director, Clinical Network Management, Horizon Blue Cross Blue Shield of NJ, Newark, NJ

Kenneth Faistl, MD
Family Practice of Central Jersey, Freehold, NJ

Thomas McCarrick, MD
Town Medical Associates, Verona, NJ

Cari Miller
Director of Advocacy and Project Operations, PCMH Pilot Project Director, New Jersey Academy of Family Physicians (NJAFP), Trenton, NJ, (Moderator)

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