Study Site: Gotham Hospital
Gotham Hospital is a large urban-based not-for-profit medical center in the New York City (NYC) Metro Area serving a population of approximately 500,000 residents who live in Bronx County. The hospital has: 1,060 total acute care beds on two campuses; a network of 19 primary care; two specialty ambulatory care centers near Gotham hospitals; a 420,000 visit home health agency providing short and long term care to home bound patients; a unified, enterprise-wide clinical and business information system connecting all of the above components. There are more than 800 house staff members and 800 full-time academic faculties in all clinical specialties at Gotham (Boucai and Zonszein, 2007). Gotham hospital has three general hospitals and one children’s hospital along with 23 community primary care centers, 16 school health centers, 3 major specialty care centers, 2 special care units, and 4 emergency departments (Ashkenase, 2010).
Medicare and Medicaid make up the largest portion of the hospital’s payer mix at 80%, ( Medicare 37%, Medicaid 43%) while commercial (13%) and other tertiary insurance make up 20% of healthcare coverage carried by patients (Chase D, 2010) (Exhibit 1). Specific figures for the number of uninsured patients that receive services at Gotham were not available. Over the last several years the hospital has seen an increase in the number of cases of bad debt, i.e. unpaid patient accounts, and Charity Care, which includes an increase of $62 million from 2007 ($126M) to 2009 ($188M) (Ashkenase, 2010).
As a part of its 120-year tradition, the hospital has provided healthcare access to the poor, immigrants, and medically underserved patients in the Bronx. 90% of Gotham’s patients are from the Bronx or Westchester. The hospital employs modern disease management concepts, using evidence-based medicine and population surveys.
This capstone project aims to study the diabetes management unit at Gotham Hospital (the study site), a subsidiary unit at Gotham, which is a member provider of The Bronx area ACO structure. The group aims to evaluate how the coordination of care across the various provider groups comprising a typical ACO model (The Bronx ACO Group) will lead to cost reduction through patient centered integrated care in managing a typical chronic disease (Diabetes). The group will analyze the various contributory variables that are responsible for increased cost of management of diabetes Pre-ACO and evaluate how these factors can be addressed Post-ACO. However, since one of the major effects of the ACA reform leading to the formation of ACO is universal coverage for all Americans, special emphasis will be placed on how to reduce the cost of managing diabetes through increased access and utilization of services by the target population. Accordingly, the team will research the contributory factors responsible for underutilization of the services and offer appropriate recommendation on how to increase enrollment as a long-term measure to reduce the cost burden of diabetes. [Isn’t the issue really participation vs. enrollment? i.e., controlled vs. uncontrolled diabetes? Isn’t that the purpose of the ACOs?]