Division of Medical Assistance and Health Services
Payers:
Medicaid
Description:
In August 2011, Governor Christie signed into law NJ P.L. 2011, Chapter 114 requiring DMAHS to establish a three year Medicaid Accountable Care Organization (ACO) demonstration project. ACOs are designed to improve health outcomes, quality and access to care through regional collaboration, and shared accountability while reducing costs.
The Medicaid ACO demonstration project provides the New Jersey Medicaid program an opportunity to explore innovative system re-design including; testing the ACO as an alternative to managed care; evaluating how care management and care coordination could be delivered to high risk, high cost utilizers; stretching the role of Medicaid beyond just medical services but to integrate social services; and, testing payment reform models including pay for performance metrics and incentives.
New Jersey ACO applicants are required to be a nonprofit organization serving a minimum of 5,000 Medicaid beneficiaries within a designated region. In addition, the ACO is required to contract with 100% of the hospitals, 75% of the primary care providers and at least four mental health providers within the intended service region.
The first board meeting is set for August of 2014 and the community advisory group will be determined this fall; behavioral health, pain management and community groups must participate for the ACO to be successful.
