Balance Accountable Care Organization
(Balance ACO) under the Affordable Care Act
 
Began July 1, 2012 as a group Physicians, providers of and suppliers of medical services (e.g., hospitals, long-term care facilities and others involved in patient care) that work together to better coordinate care for the Medicare Fee-For -Service patients we serve.
 
The goal of the ACO is to deliver seamless, high-quality care for our Medicare beneficiaries that are not enrolled in a health plan. The Medicare Shared savings program creates incentives for health care providers to work together across care settings and will reward the ACO when we lower the growth of healthcare cost while meeting performance standards on quality of care.
 
Our New York State designated Health Home – Northern Manhattan Health Home, in collaboration with numerous community partners, is answering the needs of the Medicaid population with chronic conditions.
The Health Home is providing comprehensive medical, mental health, chemical dependency, housing and case management services to thousands of Medicaid patients.


Delivery System Reform
Incentive Payment - DSRIP
 

We have been granted the designation, by NYS Medicaid redesign team, as an “Emerging Performing Provider System” ( PPS). Our intent is to develop a patient – centric, integrated healthcare PPS network to cover all five boroughs of New York City and Nassau County.

We will partner with other safety- net service providers in order to reduce avoidable hospitalizations, improve access to health care and improve health outcomes.



The one physicians group
applying for waiver money



By Dan Goldberg

Jul. 28, 2014

 

Of the 50 provider systems seeking money from the state's $8 billion Medicaid waiver program, only one is led by a physicians' group.

AW Medical filed on behalf of several dozen other provider groups with several hundred physicians, creating a new entity called New York Community Preferred Providers, and is waiting to see if the state will award them a $3 million planning grant.

That money would be used to devise a way to implement reforms that ideally provide better, more cost effective care for the 750,000 Medicaid lives this new entity would cover, according to Dr. Ramon Tallaj, C.E.O. of AW Medical, and Hal Sadowy, Chief Operating Officer for NYCPP.

The group is also applying for a separate $25 million capital grant to build new urgent care centers, which, they say, will be an important part of keeping people out of emergency rooms.

Almost all the other applicants have been hospitals or health systems whose vast infrastructure makes them natural choices to lead new projects.

But AW Medical argues that because its doctors represent a range of cultures and ethnicities, and have experience treating a Medicaid population, it can offer a unique perspective when it comes to providing the kind of collaborative care the Medicaid waiver money is designed to spur.

The waiver, an agreement between the state and federal government, sends $8 billion to New York State, which will be used to implement a variety of programs and reforms aimed at reducing in-patient admissions by 25 percent during the next five years.

AW's application to the state for a planning grant explains that NYCPP will bring together more than 1,600 community-based physicians who serve more than a quarter of the Medicaid patients in the Bronx, Manhattan, Brooklyn, Queens and Nassau County.

Their proposal says they will focus on cardiovascular health, diabetes, asthma and integration of primary care and behavioral health, as well as increasing access to preventive care.

For example, Tallaj and Sadowy said they would want funding for new I.T. to improve communication among the varying doctors who treat patients with chronic diseases.

It's relatively intuitive, but not always practiced in the current health care system.

“When one of my patients goes to the E.R., sometimes I have no idea that happened because I was never called, so sometimes tests are repeated,” Tallaj said.

The waiver money is designed to fix those kinds of miscommunications, with the aim of improving patient health and reducing costs.

In practice, the improved system could look something like this: a child comes in with a belly ache, and a physician doesn't see a physical problem but suspects emotional stress could be leading to acid production causing discomfort. The physician suspects the home environment may be the cause of stress. Integrating the system allows for the primary care doctor's notes to be seen easily by a behavioral health therapist who is in the same network. A better I.T. system allows the E.R. doctor to see the behavioral health specialist's notes if the child ever shows up in the E.R. Each case saves a little bit of time and a little bit of money but in the long run, the hope is that it adds up to big improvements and big savings.

“The difference is there is a coordination of care,” said Dr. George Liu, C.E.O. of Chinese American IPA and chairman of the Asian American Accountable Care Organization, which are under the NYCPP umbrella. “There is going to be some money to integrate those systems.”

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