Allegiance ACO provides care services to economically disadvantaged patients and their families at or below poverty level who reside in suburban and underserved urban communities in Mercer County, N.J. Since the ACO's formation in 2013, Medicare patients have increased from 2,867 to an estimated 12,000, and 52 physician members are expected to grow to a projected 120 in 2017.
"We are a small group of providers working with patients from the inner cities of central New Jersey who still managed to achieve federal savings, reduce spending and significantly have an impact on cost utilization," said Marc Whitman, M.D., Allegiance ACO's CEO. "From day one, HealthEC's best clinical practices and deep knowledge of population health management enabled Allegiance ACO to be successful. Its technology solution eliminated the burdensome back office work so that our physicians could focus on what they do best – delivering high quality patient care to their patients."
From the beginning, HealthEC's population health management solution helped launch and assist Allegiance ACO to manage care coordination of its high-risk stratified Medicare beneficiaries in Trenton and surrounding areas. Specifically, the ACO's patients have a higher rate of kidney dialysis utilization compared to the national average dialysis patient population. However, with support from HealthEC, Allegiance ACO is able to keep dialysis costs under control.
HealthEC's solution captures, aggregates and normalizes clinical and financial data from diverse ambulatory and acute electronic health records, claims and ancillary systems onto a single, comprehensive platform. Its granular analytics applied to large data integration identifies Allegiance ACO's high-cost, high-risk patients, requiring close medical attention—by provider and by practice. It also provides strategic insight into which risk-rising patients have the greatest impact on minimizing cost utilization.
Allegiance ACO's large-scale data integration also laid the groundwork for the development of a collaborative care coordination program that resulted in nearly $1 million in shared savings. The investment in the ACO opened a budget to hire three care coordinators. Over three years, each care coordinator assigned to a group of practices tracked approximately 800 stratified high-risk patients and their health progress, and made preventive care interventions and decisions specific to each individual's condition. Through their work, the average annual patient's cost dropped by about $700. Allegiance credits this savings to a decrease in unnecessary emergency department visits, hospitalizations and other high-expense care services.
According to Sanjay Seth, M.D., HealthEC Executive Vice President, "With Allegiance ACO's particular population, it's harder to control costs without restricting patient's choices and mobility in selecting a doctor of their preference. We, however, were successful empowering these patients to act upon their choices in partnership with their doctors. Our coordinators, in fact, actively engaged patients' behavior to manage their health, while we guided each practice's operations in the pursuit of controlling costs."
"Together, Allegiance ACO and HealthEC have made significant progress improving practice efficiencies, minimizing utilization costs and maximizing support from practice partners," Dr. Seth continued. "We're proud to support this small but powerful group of physicians dedicated to providing the best care possible to this vulnerable patient community most in need of medical care. Our technology also averted the costly expense of all physician members having to adopt a new EHR system."
Allegiance ACO partners included: Ocean Healthcare, a multi-faceted management entity that oversees a broad range of operational areas for 13 New Jersey-based long-term care facilities, two acute care hospitals, Medicare-certified home healthcare, hospice services, an assisted living community, and two adult day care centers.
HealthEC further developed the profit distribution methodology entailing cost utilization metrics for measuring practice performance to allocate the federal payments to physicians.
About Allegiance Health Group
Allegiance Health Group (AHG) was established in December 2012, started operations in June 2013, and currently has 43 physician members across 28 practices. The group is comprised of approximately 28 PCPs and 16 specialists including gastroenterologists, endocrinologists, cardiologists and infectious disease specialists. The group claims to care for 85,000 patients with more than 188,000 patient encounters. The group was capitalized by each physician to cover organizational, legal and accounting services to establish the group and the Management Services Organization (MSO), and to create a physician owned laboratory in January 2015. AHG physicians manage approximately 68,000 lives. AHG physicians direct patients to Capital Health (Trenton and Hopewell), St. Francis Medical Center, RWJ Hamilton, and Princeton Medical Center.
HealthEC is a KLAS-recognized population health management company integrating data from hundreds of EHRs, labs, claims and other sources to reduce overhead costs and improve care coordination for IPAs, CINs, ACOs and health systems. The company's clinical analytics identify provider-specific patterns and guide patient care interventions for better outcomes, lower cost utilization and a positive ROI for their clients. Visit www.HealthEC.com; follow us on Twitter, LinkedIn and Facebook; or call 800-444-0278, ext. 1500 for more information.
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