BCBSIL announces four new ACO agreements to improve patient care

Blue Cross and Blue Shield of Illinois (BCBSIL) announces four new, strategic agreements aimed at improving patient care while slowing health care cost trends. Accountable Care Organizations are a value-based care model that seeks to move the healthcare industry's payment structure from one based on fee-for-service, or volume, to one that reimburses based on the quality of patient outcomes and patient care. In an ACO, both the payer and provider share financial risk, and in return, shared savings, while improving the care that is delivered.

BCBSIL's provider-partners in the four new ventures will have more than a combined 111,000 patients participating:

1. Kane County Independent Physician Association, a physicians group
2. Alexian Brothers Health Systems, a five-hospital network based in Arlington Heights
3. North Shore University Health System, a four-hospital network based in Evanston
4. Presence Health, with 11 hospitals across the state

"We work with each provider to better coordinate care and share valuable data that helps direct providers' efforts toward where the data trends point. Each provider group then agrees on a set of quality measurements and improvement goals, including reducing inpatient stays and emergency room visits, avoiding unnecessary readmissions, along with improving key care quality measurements," said Jerry Bradford, vice president for Network Management, BCBSIL.

"These new ACOs- a partnership with providers and health systems- now brings our total to nine ACOs, with the first such commercial ACO being initiated in 2010 with Advocate Health Care, the state's largest hospital healthcare system."

Kane County Independent Physicians Association (IPA)

"While each partnership is unique, it's the second time we've created an ACO with an established physician-owned- only practice like Kane County IPA," says Bradford.

This IPA has more than 78 participating physicians who have come together to advance the future of healthcare by transforming the way independent physicians coordinate and deliver patient care to their 7,100 patients.

"Kane County IPA believes that this collaboration with BCBSIL provides a mechanism to support and maintain the independent physicians in our community," says Jose Trevino, M.D., Kane County IPA President and Medical Director. "In this day with increasing demands from the marketplace with downward pressure on reimbursements, we hope to provide a haven for these independent physicians as we compete with bigger, better funded health systems."

Alexian Brothers Health System

"This ACO is the first such effort with a private insurer for Alexian Brothers Health System", said Don Franke, vice president for clinical integration at the health system. Alexian plans to take lessons it learned in its other ACO, with Medicare, and apply them to the 14,000 patients in the Blue Cross effort, he said. That includes considering issues at home that might impact patients' health, such as not having transportation to get to a doctor.

"We're able to identify patients who we think would benefit by having their care better coordinated," Franke said.

There are 14,000 patients and more than 110 primary care and specialist physicians affiliated with the new ACO partnership between Blue Cross and Alexian Brothers.

NorthShore University HealthSystem

"This collaboration is about physicians working together to deliver the highest quality and most cost-effective care for patients. As the healthcare landscape undergoes remarkable change, such partnerships are imperative, and NorthShore is pleased to be part of an initiative that will improve efficiency, coordinate care and enhance value for patients," said J.P. Gallagher, Chief Operating Officer, NorthShore University HealthSystem.

There are 62,000 patients and 255 primary care physicians and specialists in the BCBSIL/North Shore University HealthSystem.

Presence Health

David DiLoreto, M.D., chief clinical officer of Presence Health Partners, a network of about 2,500 physicians affiliated with Presence Health, said, "One of the things we're hearing from people who pay for health care, whether that's employers or the government, is that the cost of care is too high and the quality doesn't seem to support the cost of care." The Presence ACO with Blue Cross includes about 33,000 patients.

The Early Adopters: Advocate Health System and OSF Healthcare

The Advocate ACO agreement impacted more than 250,000 patients, and represents the nation's largest commercial ACO to date. Interest in and the growth of ACOs is a product of the early demonstrated success that illustrates how such agreements have the potential to be a victory for providers, payers, and most importantly, patients, with the eventual objective of lowering health care costs for all while improving healthcare quality.

That early arrangement — now in its fifth year — demonstrated success and the potential of ACOs. Over the first three years of the ACO agreement between Advocate and BCBSIL the medical cost trend was reduced by six percent when compared to the rest of the BCBSIL PPO population in the market. The cost reduction was coupled with improved clinical outcomes for patients, such as lower readmission rates.

Blue Cross built on that success by partnering with OSF Healthcare, Central Illinois' largest hospital health care system to launch a sweeping ACO agreement that covered 40,000 OSF patients and Blue Cross members. By advancing that commercial ACO, it complemented OSF's own work as one of just 32 organizations chosen by the Centers for Medicare & Medicaid Services (CMS) to participate as a Pioneer ACO for the federal government.

Three Additional ACOs Launched July 2014

In July of 2014, BCBSIL launched three more ACOs, with a combined 110,000 patients participating:

1. Independent Physicians' ACO of Chicago
2. Northwest Community Healthcare
3. Illinois Health Partners (the combined Edward Hospital and Medical Group, Elmhurst Hospital and Medical Group, and DuPage Medical Group)

"All of these arrangements represent a continuing shift in the evolving nature of how we pay for medical services, and it moves reimbursement away from costly and uncoordinated fee-for-service payments to those that are payments for value," said Bradford. "In addition, the arrangement enables the providers to utilize clinical data and best practices to help drive medical decision-making, enhance patient safety and improve quality of care — all supporting the goals of better health and improved outcomes for our BCBSIL members."

SOURCE Blue Cross Blue Shield of Illinois