October 15, 2015
Co-presenters answer participants’ questions on innovative approaches to payment reform for low-income and vulnerable populations in the state of New Jersey that were not answered during the webinar.
One of the challenges that many people in this population face is the high number of adverse childhood experiences (ACEs). Can you address this, and also discuss the difficulty that providers and care managers have in gaining the trust of patients so that patients can be open about discussing those ACEs?
In our experience at the Camden Coalition of Healthcare Providers, we work with many complex patients with high numbers of ACEs. We have had a lot of success working with them because we take the time and approach required to develop a genuine healing relationship. This includes approaching patients with unconditional positive regard, deploying techniques such as motivational interviewing and harm reduction philosophies, and limiting caseloads to enable staff to invest in relationships and overcome individual barriers to their trust. Here is a link to a poster, and a peer reviewed article on the same topic is forthcoming.
There is no government financing of the ACOs at present, and participation in managed care organizations (MCOs) is voluntary. Camden has two MCO contracts that include upfront payments and the potential for shared savings. New Jersey received approval from the Federal Trade Commision (FTC) to take advantage of the state action doctrine exemption to anti-trust law. It also included the ACO Demonstration Project in its 1115 waiver, which was approved in 2012.
These are not subject to shared savings since they would occur regardless of ACO activity.
There is no uniform payment to the ACOs. It is a voluntary program that each MCO can choose to contract with or not. At present, the Camden Coalition has contracts with two MCOs (UnitedHealthcare and Horizon NJ Health), both of which include upfront payments for care coordination services and the opportunity for shared savings.
United also has shared savings arrangements with federally qualified health centers (FQHCs), like CAMCare (which was highlighted in the webinar), that include a PMPM and shared savings.
No. At present, none of the ACOs are providing Services for which they can bill fee-for-service.
Ninety-five percent of New Jersey Medicaid recipients are enrolled in an MCO. MCO participation is really crucial.
Rutgers Center for State Health Policy (CSHP) has proposed a risk adjustment methodology using the Chronic Illness and Disability Payment System (CDPS). This does adjust for having a prior history of psychiatric or substance abuse diagnosis. It does not account for social determinants.
We do not have plans to speak with patients. This would provide important insights, but would be too resource-intensive. Instead, we will conduct a very focused analysis of processes and other activities at the provider level.
This was the most challenging requirement and the one that several applicants failed to met. Those that met the requirement have organizations that have been around for a number of years and have long engaged primary-care providers. The Camden Coalition began as a primary-care provider breakfast group 13 years ago and has been working alongside the city’s primary-care providers for many years. The number of independent primary-care physicians (PCPs) has fallen; most are affiliated with one of the three major health systems or two FQHCs that are part of the Camden Coalition.