CHCS - Center for Health Care Strategies

Improving the quality and cost-effectiveness of publicly financed health care

The New Jersey Medicaid Accountable Care Organization Business Planning Toolkit

Type:
Toolkits
Author:
Rob Houston, MBA, MPP, and Tricia McGinnis, MPP, MPH, Center for Health Care Strategies; Bruce Dees, Applied Health Strategies; and Derek DeLia, PhD, Rutgers Center for State Health Policy
Published:
June 2013
Funder:
The Nicholson Foundation

In New Jersey, groundbreaking legislation is enabling communities to test the viability of accountable care organizations (ACOs) to improve care and curb spending for Medicaid beneficiaries, particularly those with chronic needs. Through the three-year Medicaid Accountable Care Organization Demonstration Project, the state is supporting community-based efforts to coordinate care across health settings, including hospitals, provider's offices, clinics, and home care.

Even prior to this legislation, New Jersey was at the forefront of the national ACO movement, with two promising urban-based models. The Camden Coalition of Health Care Providers has received national attention for its success in identifying "super-utilizers" and deploying innovative care teams to coordinate their care. The Trenton Health Team is expanding access to primary care and developing community-wide care coordination in the state's capital.

To guide New Jersey communities in designing ACO demonstration projects, the Center for Health Care Strategies (CHCS) developed The New Jersey Medicaid Accountable Care Organization Business Planning Toolkit. The toolkit, made possible through The Nicholson Foundation, provides step-by-step guidance and templates to facilitate ACO planning. Content is organized within three sections: 

  • Building the ACO Framework - Outlines the rationale for developing an ACO, summarizes state and federal regulations and walks through conducting a community readiness assessment; 
  • ACO Nuts and Bolts - Details basic and advanced steps for ACO development in five core areas: (1) leadership and governance; (2) stakeholder partnerships; (3) data analysis and information technology; (4) enhanced care delivery; and (5) quality improvement.
  • Constructing the ACO - Guides prospective ACOs in developing business and work plans.

While the toolkit is geared toward New Jersey, the guidance and practical templates can help Medicaid stakeholders across the country in developing ACO models aimed at improving care and controlling costs for beneficiaries with complex needs.


ACO Planning Templates

The toolkit appendices include the following three templates to help guide ACO planning:

  • The Readiness Assessment - This planning activity will identify areas that need further development as outlined in the "ACO Nuts and Bolts" section.
  • The Business Plan - The business plan can guide ACO leadership to work toward financial sustainability, prioritize funding for areas in need of development, and guide informal cost-benefit analyses.
  • The Work Plan - The work plan prioritizes the needs outlined in the readiness assessment and business plan and can be used to help guide the division of labor among partners and match revenue streams to tasks that must be accomplished within a defined timeline.

 

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