One key factor sets Robert Wood Johnson Partners apart from other attempts at reform -- the Accountable Care Organization has the power of a major research university behind it
During nearly three decades as a primary care physician, Alfred Tallia has identified a daunting list of flaws with the nation's health care.
Specialists rarely coordinate care for patients with chronic illnesses such as diabetes and high blood pressure -- which can lead to repetitive, expensive tests.
In most doctors' offices, no one is responsible for developing plans with patients to lose weight, exercise and change their diet -- or for following up with those patients to help them meet their goals.
But Tallia, chair of the Department of Family Medicine and Community Health at Robert Wood Johnson Medical School -- now part of Rutgers -- is getting ready to launch a solution he believes will deliver more effective care at a lower cost.
"The idea of improving quality and controlling costs, that is something here to stay,'' Tallia said. "We can't keep spending 18 percent or more of the Gross Domestic Product on health care, not cover everybody and have disappointing outcomes. That is what we have now.''
Tallia is spearheading the creation of an Accountable Care Organization, called Robert Wood Johnson Partners, that will coordinate treatment among doctors, other health professionals, and hospitals through better use of electronic health records. The project also involves restructuring doctors' offices to improve communication with patients, and directly involve them in developing plans to benefit their health.
Although similar efforts have been rolled out around the country since health care reform became law in 2010, one key factor sets Tallia's work apart :
Robert Wood Johnson Partners has the power of a major research university behind it.
Tallia and others in the medical school -- in partnership with Robert Wood Johnson University Hospital and Health System -- are teaming up with researchers across different disciplines at Rutgers to find the best ways to improve care and curtail costs. This includes the School of Engineering, the Department of Psychology, and the School of Communication and Information.
"The reason for Robert Wood Johnson Medical School and Rutgers to be involved is to answer the many outstanding questions about how a system should work,'' Tallia said. "We are in the best position not only to deliver care, but to also do the research to make it better.''
For example, a professor in the School of Communication and Information plans to study the use of a patient portal, an online information hub that would allow patients to access test results and other health information. The technology will also allow patients to schedule appointments, request or renew prescriptions, pay bills and ask questions about their care.
Graduate students from the Department of Psychology in the School of Arts and Sciences and the Graduate School of Applied and Professional Psychology will work in a primary care practice to help patients quit smoking, improve eating habits and address other behavioral health issues.
And professors in the School of Engineering will use mathematical modeling and statistical analysis to study workflow in the primary care office and define the role of a patient care coordinator. The person in this position would be dedicated to helping patients adhere to plans for their health -- which could involve communicating with pharmacies to make sure prescriptions are filled, keeping tabs on exercise plans and coordinating appointments.
"Part of what the engineering department is going to do is help us make our care more efficient so we can spend more time on things that really matter,'' said Elizabeth C. Clark, an assistant professor in the RWJMS Department of Family Medicine and Community Health.
"If doctors are spending less time doing paperwork they will have more time to spend with patients,'' Clark said.
The medical schools, nursing, pharmacy, and other professional programs at Rutgers can also build on lessons learned to train a team-based workforce suited to meet the health care needs of the future, Tallia said.
Brian L. Strom, the incoming chancellor of Rutgers Biomedical and Health Sciences who is also a primary care physician, echoed concerns about the health care system and called Tallia a "national leader in this area.''
"As a nation, we need to move away from an episode-based disease management system,'' Strom said.
"This will require a multidisciplinary approach to population health, and a multidisciplinary approach to evaluating the new models of care that emerge, like the ACO planned by Dr. Tallia. Rutgers, with its depth and breadth across health and non-health fields, is enormously well positioned to be a leader in this field."
A Timeline for Providing Care
Robert Wood Johnson Partners is seeking approval to start treating Medicare patients early next year. The Affordable Care Act encourages the creation of such Accountable Care Organizations for Medicare patients, but most have been developed around hospital systems.
Rutgers would be one of the first academic institutions to launch such an organization, Tallia said.
Tallia is also talking to some of the state's major health insurance companies including Horizon Blue Cross Blue Shield and Aetna to expand into a statewide organization next year called Rutgers Health Partners.