Healthcare: Payment Reform

Transforming the delivery of healthcare services is more likely to be successful if it is accompanied by effective reimbursement methodologies. The current fee-for-service payment system reimburses providers for each office visit, procedure, and test without regard to health outcomes. This incentivizes more, rather than better, care. The current system also does not compensate providers for additional services that are known to contribute to improved health outcomes. These services include coordinating care—especially for the highest users of healthcare services—among multiple clinical providers and social services agencies, and helping patients and their families more fully understand and manage their conditions.

Members of the ACO learning network.

The Foundation supports payment reform efforts that reward value—higher quality and lower costs—rather than volume. We work as both a catalyst and an accelerant, helping to build ACOs from the ground up and providing the ACO community with the resources they need to thrive.  For example, we have worked with:

On June 30, 2015, the State of New Jersey certified three of these coalitions—the Camden Coalition of Healthcare Providers, the Healthy Greater Newark Accountable Care Organization, and the Trenton Health Team—as Medicaid Accountable Care Organizations (ACOs). The Governor’s 2016 State budget includes $3 million to support their continued development.   

  • A statewide ACO learning network, which provides advocacy services and is training and providing technical assistance to the three certified Medicaid ACOs and two other community healthcare coalitions, called “ACO look-alikes,” that are providing similar types of services.   
  • A three-year evaluation of the Medicaid ACOs and the ACO “look-alikes,” which will examine their operations and care management strategies, identify challenges they face, and describe plans for addressing the challenges. 

Visit our Projects page to learn more about The Nicholson Foundation’s funded projects.

For additional information about the communities that have applied to become Medicaid ACOs, visit the Accountable Care Organization webpage of the New Jersey Department of Human Services, Division of Medical Assistance & Health Services.