Delaware ACO Accelerates Coordinated Care through Local Partnerships

December 2, 2020

By Ahmed Haque

The Aledade Delaware ACO is gaining momentum on several fronts in our mission to usher in a new model of primary care. Last year, our ACO doubled in size, and we continue to recruit top independent primary care practices across Delaware that are ready to embrace change by participating in value based programs. Last month, we started participating in the state’s Practice Transformation Services Program in partnership with Remedy Healthcare Consulting. And this week we are excited to announce a new set of agreements that will benefit providers and patients across the state.

Aledade is committed to closing the gaps in health care – coordinating patient care more seamlessly and effectively. In order to do that, primary care physicians need to know what happens to their patients when they see specialists and get treatment outside the four walls of their office. These new arrangements in Delaware will help us do just that – shed light on the care patients receive outside of their primary care practices and empower our Delaware ACO practice partners to deliver coordinated, high quality care.

First, we have recently formed a new partnership with one of the largest groups of hospitalists in Delaware, IPC Healthcare. This will give our ACO practices the ability to share patient data, advise on care, and coordinate with the hospitals where their patients receive care. Partnerships like this are important to value-based care as they reduce unnecessary tests, ER visits, and hospitalizations while improving the care patients receive with provider data access. Aledade’s ACO practices can now also directly admit patients to local hospitals when appropriate, instead of first going to the ER. Doing so, when appropriate, will reduce cost and the time patients spend getting the care they need.

Second, we have upgraded our agreement with The Delaware Health Information Network (DHIN), the state’s health information exchange. While they have long provided patient data on a twice daily basis to our Delaware ACO, the DHIN has now taken the next step, and is providing Aledade ACO practices with real-time patient update. This means primary care physicians will be notified right away if their patient is admitted, discharged, or transferred from a care facility. With real-time data from DHIN, ACO practices will be able to provide more timely follow up with their patients during transitions of care. Transitions of care management are an important focus for Aledade’s ACOs, and an important aspect of providing seamless care.

Another development in Aledade’s data connection with DHIN is that Aledade now receives notifications and data from MedExpress through the health information exchange. MedExpress is a large network of walk-in clinics throughout Delaware, so having real time data from these clinics gives our ACO practices more detailed understanding of the care our ACO patients receive outside of their primary care practices. This too is an important aspect of providing seamless, coordinated care, and we are in the process of arranging further partnerships with walk-in clinics throughout the state.

Lastly, we now have a care compact with The Heart and Vascular Clinic, PA (HVCA) in Delaware. While Aledade believes primary care is the core of a coordinated, effective health care system, we also know that high-quality specialists are a critical piece of the puzzle. That’s why we work to arrange care agreements with high-quality specialists, such as our cardiology referral management program with The Heart and Vascular Clinic, PA (HVCA) in Delaware. These agreements focus on improving care coordination, access, and effectiveness through communication and information sharing, including test outcomes and consultation notes. For patients, this means they can see an HVCA provider within 48 hours for an urgent visit and receive more seamless care.

Taken together, these new agreements and updated services will strengthen the Delaware ACO’s ability to coordinate care, resulting in improved quality and lower overall costs.