New Jersey Prepares to Launch Accountable Care Organization

New Jersey is one of the first states to experiment with accountable care organizations, or ACOs, a relatively new health care model that is similar to the patient-centered medical home, or PCMH, and that links primary care and subspecialist practices with area hospitals to create an integrated delivery system. Providers are accountable for costs and the quality of care delivered, and bonuses and penalties are tied to overall spending and quality measures.

The Robert Wood Johnson Medical School in New Brunswick, N.J., will oversee operation of the test ACO, which will operate in the central part of the state. It is expected to launch in January, and will be primary care-based, will consist of 100 to 150 primary care practices and some subspecialty practices, and will be linked to five or six area hospitals, according to Alfred Tallia, M.D., M.P.H., president and chair of the department of family medicine at the Robert Wood Johnson Medical School.

"It will be a totally integrated delivery system," Tallia told AAFP News Now.

Primary care practices interested in participating in the test project must have achieved Level 1 recognition in the National Committee for Quality Assurance's, or NCQA's, PCMH recognition program, according to Tallia.

"We want (test practices) to become advanced medical homes, so we are hoping to work with them to facilitate their NCQA (recognition) as the highest-level medical home," he said.

An independent third party will work with participating primary care practices to help them achieve advanced NCQA recognition, said Tallia. This third party also will provide participating primary care practices with electronic health records, recruitment and staffing assistance, and help negotiating better contracts with insurance companies.

Ken Faistl, M.D., a family physician in Freehold, N.J., is planning to participate in the ACO. He says it will give his practice and others the opportunity to be compensated for providing value-added services. All too often, family physicians are held accountable for systems over which they have no control, said Faistl.

"I want physicians who provide good care and a good product to be compensated for that," said Faistl, who is the director of the University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School Family Medicine Residency at CentraState Medical Center in Freehold.

The ACO also should help family physicians coordinate care with other providers, and allow FPs to use their skill set across a geographic region, said Faistl.

Nevertheless, Faistl said he has "concerns about how the ACO's financial structure will work," and in particular, about how family physicians will be compensated for care-coordination and other value-added services.

Officials have not yet determined the financial structure of the ACO or how to apply any bonuses or penalties, said Tallia.

He noted, however, that New Jersey has a huge shortage of primary care physicians, including family physicians. The hope is that the ACO will help attract additional primary care physicians to the state.

But the biggest beneficiaries will be the patients themselves, because the ACO will result in marked improvements in patient care, said Tallia. "I think there will be significant tangible results from a quantitative standpoint in terms of quality of care and also the cost of care."