How Blue Cross and doctors are working together to lower medical costs – Health Care News

on May7

4 May 2017 | 10:30 am

About 1 in 4 members of Blue Cross & Blue Shield of Illinois are now part of an initiative that has taken hold nationwide to lower medical costs.

The Chicago-based health insurer, the dominant player in the state with more than 4.2 million members, has nearly doubled partnerships that reward doctors and hospitals for keeping closer tabs on patients to prevent unnecessary care, like expensive overnight hospital stays.

Those partnerships are called accountable care organizations, or ACOs. They emerged in the wake of the 2010 Affordable Care Act, known as Obamacare. Before federal health reform, insurers traditionally paid hospitals and doctors for each service they provided, which was an easy way to rack up bills.

WHAT ACOS DO

Enter ACOs, which insurers use to cut costs and trim unnecessary care by making providers more financially accountable for their patients. This year, it doubled the number of collaborations to 20, from 11 in 2016 and just six in 2015. New partnerships in 2017 include doctors groups affiliated with Lurie Children’s Hospital, University of Chicago Medicine and Northwestern Medicine, among others.

It’s part of a strategy Blue Cross embraced before many other insurers nationwide, and one it plans to grow in the coming years.

“Our direction is, how do we continue to provide value by lowering costs in a sustainable way and improving quality?” said Donna Levigne, a Blue Cross senior vice president.

One way: Insurers pay doctors to focus on prevention and curb their patients’ expensive habits (for example, visiting an emergency department for a cold). These efforts can be risky, but rewarding. Blue Cross and doctors share financial savings they get by improving the health of patients. But providers can lose money if they don’t.

THE RESULTS

Blue Cross was an early adopter of ACOs, rolling out its first one in 2011. Today, about 10 percent of the nation is covered by these types of partnerships, said David Muhlestein, who tracks ACOs as the chief research officer at Leavitt Partners, a Salt Lake City-based health care consultancy.

“Illinois and Chicago are at the top end of that curve,” Muhlestein said. “It’s one of the most forward-looking markets, and Blue Cross & Blue Shield of Illinois is a big player in that.”

Here’s a glimpse into how ACOs overall have been working for Blue Cross: 16 percent fewer emergency department visits; 15 percent fewer hospital admissions; and $17 less spending per patient per month. This snapshot compares October 2015 to September 2016 to the same time period a year earlier.

‘TRANSPARENCY CAN HELP US DO BETTER’

Scott Wilkerson is executive director of Lurie Children’s Health Partners Clinically Integrated Network, a physicians groups that’s partly owned by the Streeterville-based specialty hospital. The group’s ACO with Blue Cross has about 85,000 children. Blue Cross shares claims data with the group to help doctors see how their patients use (or overuse) medical care. They’ve already found kids who end up in the ER too frequently, Wilkerson said. In those cases, a care coordinator would reach out to the parent, talk about concerns that might not be medical-related (think issues at school or home), and ask if the child has seen the doctor lately.

“We believe that transparency can help us do better,” said Wilkerson, adding that it’s not common for doctors to get large amounts of claims data about their patients from insurers.

Lurie Children’s Health Partners also must meet certain benchmarks, such as making sure their patients get flu shots and vaccinations on time.

Blue Cross’ Levigne said the insurer is in talks with many providers to expand ACOs that target chronic conditions in particular. For example, Blue Cross and Northwestern this year formed an ACO for endocrinology, which includes patients with diabetes. The disease can be tedious and expensive for patients, involving pills or insulin and medical devices to help manage their blood sugar. A spokesman for Northwestern Medicine declined to comment.

Gear up for ACOs to gain steam across the country, Muhlestein said. Doctors and hospitals will want to experiment on these collaborations before insurers essentially require them, threatening their bottom lines.



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