Gotham ACO Operational Structure [perhaps a systems chart would be useful]

The Gotham Hospital ACO is part of The Bronx Community ACO consisting of Integrated system of various providers who come together to coordinate and institute patient centered service delivery. The various service providers in the ACO model include:

• Gotham and other hospitals in the Bronx community ( Bronx Lebanon and St. Barnabas Hospital )

• Pharmacies ( Bronx Community Pharmacy)

• Consultant Physicians ( Gotham faculty Practice, Gotham and other IPA)

• Care Management Services (Gotham CMO [define], the Care Management Company, Universal Behavioral Associates)

• Home Care Unit ( Gotham Home Care, Visiting Nurse Services)

• Long-Term Care Unit ( St Barnabas Nursing Home, Bronx Lebanon Nursing Home, Jewish Home Lifecare, Kings Harbor)

• Mental Health Services (Gotham MHS, Bronx Lebanon MHS, Soundview Throg Neck)

• Organizational Relationships/HIE Infrastructure and Analytic Support (Bronx RHIO, EHIT

• Health plans and Insurers ( Empire BlueCross BlueShield)

• Public Health and Other Agencies (NYS DOH, NYC DOHMH) (Exhibit 6)

Other providers within The Gotham Hospital network which is part of the ACO includes

• Gotham Hospital Division – Gotham Children Hospital

• Emergency Services Division – Women Health Network

• EHIT and CMO – Gotham Medical Group

• School Health Services – Faculty Specialty Network

• Mental Health Services – Homeless Care

• Dental services – Substance Abuse Services (Chase, 2011)

These ACO providers synchronize care between various units and providers involved with a patient care through a Patient Centered Medical Home (PCMH). Comprehensive and continuous medical care is provided to patients with the goal of obtaining maximized health outcomes through aligned integrated care centered on the patient. The whole unit forms a legal entity that assumes financial risk and improved care delivery through coordinated effort.

Gotham Care Management Organization (CMO); which is Gotham Hospital wholly owned subsidiary is responsible for insurance coverage. It covers 100,000 employer-sponsored insurance and 40,000 Medicare and Medicaid managed care program (AHRQ, 2012). The Gotham CMO works in coordination with other providers in the ACO to deliver integrated health care services. The Care Management Organization uses software analyzer to analyze clinical and claims data in order to stratify its enrolled patient it manages into 3 risk categories;

• Worried well 2) Functional chronically 3) Frail ill

Consequently, the ACO at Gotham employs care guidance program that includes standard protocol and process, individualized care plan and patient data report. Through House Call program, the ACO offers primary care to the elderly; takes care of the needs of patient in need of independent life style and provide psychosocial support. This coordinated care has resulted in improved patient care and cost savings.

As at now, the individual providers still receive fee-for-service payment plus Performance based incentives based on the savings achieved as a result of reduction in the cost of patient care. Apparently, reform in the payment model is still in progress as the ACO is still in the early experimental stage and has till 2017 before full implementation of all ACO payment reforms. Gotham employed providers as well as other providers in the ACO all have access to inpatient and outpatient EMR records of patient being managed by the ACO group which is connected to the Bronx Regional Health Information Organization.

Study Population (the Bronx)

The Bronx is a large and diverse urban population center divided by the Bronx River into East and West Bronx Regions. With its various communities and neighborhoods, the Bronx is ethnically, religiously, and socioeconomically diverse. Its population is predominantly Hispanic/Latino and African-American communities, while Whites, Asians, and other minorities make up the remaining demographic (Exhibit 3). The Bronx is also a county in New York State (NYS), with children making up approximately 30% of its population. Moreover, 30% of those children c