Category Archives: ACO

Colorado Wins $65 Million Health Care Innovation Grant

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GRAND JUNCTION, Colo., Dec. 17, 2014 /PRNewswire-USNewswire/ — The Centers for Medicare & Medicaid Services has awarded Colorado $65 million in State Innovation Model (SIM) funding to create a coordinated, accountable system of care that improves integration of physical and behavioral health services.

The award builds on an earlier planning grant Colorado received in 2013, which funded development and identification of four major goals:

  • Create a coordinated, accountable system of care that gives Coloradans access to integrated primary care and behavioral health.
  • Leverage the power of the public health system to achieve broader population health goals and support delivery of care.
  • Use outcomes-based payments to enable transformation.
  • Engage individuals in their care. Continue reading →

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Capital BlueCross, PinnacleHealth System Team Up to Bring Employers a New Health Insurance Option

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HARRISBURG, Pa., Jan. 13, 2014 /PRNewswire/ — Capital BlueCross and PinnacleHealth System are teaming up to offer businesses a unique new health insurance plan for their employees. Marketed as CareConnect Point of Service (CareConnect), this plan connects the benefits and services of Capital BlueCross with the physicians and facilities of PinnacleHealth. It is powered by the two-year-old accountable care arrangement between the two companies.

“It is incumbent upon insurers and health care providers to find innovative ways to help employers achieve workforce health goals and lower costs,” said Gary D. St. Hilaire, Capital BlueCross president & CEO. “CareConnect offers this service and PinnacleHealth’s reputation as a trusted provider makes this plan really attractive to businesses seeking the best possible care for their employees.”  Continue reading →

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Cigna ACO Showing Higher Quality, Lower Costs in First Year

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CONCORD, N.H. & BLOOMFIELD, Conn., December 11, 2013 – Cigna today is reporting on the first-year results from its collaborative accountable care initiative with Granite Healthcare Network (GHN), a partnership among five independent charitable health care organizations in New Hampshire.

According to a Cigna release, the program is making strides toward achieving its goals of improved health, affordability and patient experience.They also say the initiative has helped GHN deliver a higher level of care in New Hampshire while controlling total medical costs for its 30,000 patients who are covered by a Cigna health plan.

Cigna noted that when the program started last year, it evaluated how well GHN followed nationally recognized evidence based medicine guidelines (a measure of quality) and Continue reading →

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Florida Blue and Orlando Health Create Accountable Care Arrangement

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JACKSONVILLE and ORLANDO, Fla., Dec. 10, 2013 /PRNewswire/ — Florida Blue and Orlando Health Physician Partners have announced the execution of an accountable care agreement, which aims to improve the quality and efficiency of patient care in the Orlando area.

Starting on Jan. 1, 2014, the accountable care program will utilize a value-based compensation structure that i s intended to decrease medical costs and increase quality outcomes by rewarding the right combination of goals, including transparency, care coordination, consumer empowerment and lack of redundancy. – See more details at PR Newswire.com.

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Aetna, PinnacleHealth System Form Accountable Care Relationship

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Aetna and PinnacleHealth System recently announced a new accountable care agreement that is designed to improve the quality of care and lower overall health care costs for Aetna commercial plan members in the Harrisburg, Pa., area.

According to a release issued by Aetna, the collaboration will use PinnacleHealth’s comprehensive, integrated system of physicians, hospitals and ambulatory services to give area employers better health care options for their employees by:

  • Creating a more coordinated patient experience;
  • Saving employees money when they use providers aligned with PinnacleHealth; and
  • Improving health care outcomes.

Aetna says it will introduce both fully insured and self-insured health plans in Central Pennsylvania that will use PinnacleHealth’s community-based systems of care and its network of highly respected physicians. The first product, for groups of more than 51 employees, will be available on April 1, 2014. A small-group product for groups of between two and 50 employees will be introduced July 1, 2014. – See aetna.com for more details.

 

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Will ACOs Usher in a New Era of HMO-Style Managed Care?

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Amber May has published an article on BenefitsPro.com that recalls a time in the 1990s when HMOs were the biggest thing in health care. She points out that the most obvious benefit of an HMO system is the coordination of care the organizations facilitate and how, since 1995, the National Health Insurance Law in Israel made participation in one of the four Israeli HMOs compulsory for all Israeli citizens.

May points out that once again the United States is experimenting with managed care. She notes that the Patient Protection and Affordable Care Act (PPACA) is attempting to address the lack of care coordination that’s developed in the American health care system by creating provisions for accountable care organizations (ACOS), coordinated groups of health care providers that provide care for specific populations of patients and are accountable for the quality, cost and outcomes of that care.

She notes that through PPACA, ACOs are tied to Medicare and speculates that a universal managed care system similar to Israel’s may be a long way off for the U.S. – To learn more see benefitspro.com.

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National Network of Post-Acute Care Providers Formed to Serve ACOs

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As Accountable Care Organizations (ACOs) begin to change the patient care model nationwide, coordination of care between acute and post-acute care providers is an important component for ACO success.

ACOs will need to partner with  Long Term Care (LTC) pharmacies, Home Infusion and Specialty pharmacies, HME and Respiratory providers, and Long Term Care facilities including Skilled Nursing, Assisted Living and Rehabilitation facilities.

To address this issue, Managed Health Care Associates, Inc. (MHA), a health care services and technology company focused on alternate site health care providers, has announced the formation of the MHA ACO Network. MHA says that by working with both Commercial and Medicare Accountable Care Organizations (ACOs), the MHA ACO Network will provide access to the largest national network of alternate site post-acute care providers in the country. – For more information, visit www.mhainc.com.

 

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New Horizon Blue Cross Blue Shield of New Jersey Product Brings Innovative Accountable Care Model to Employers

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Newark, NJ – November 7, 2013) – Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), which has been leading an effort with physicians, hospitals and health care leaders throughout the state to transform how health care is delivered, has developed a new product for employers to encourage employees to use physicians focused on improving the value of care patients receive, rather than the volume of care. The goal of the new product is to increase the number of Horizon BCBSNJ members who will seek care in patient-centered practices to improve patient outcomes and reduce overall health care costs.

The new product – the Horizon Patient-Centered Advantage EPO Plan – is now being offered to fully-insured employer groups for coverage that becomes effective on January 1, 2014.

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Study Looks at ACO Formation Drivers

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An article in Physicians Briefing points to a study published in the October issue of Health Affairs that suggests that underlying provider integration in a given geographic region may be the key that drives the formation of Medicare accountable care organizations (ACOs),

The researchers found that a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups were key regional factors associated with ACO formation.

The study is available for purchase at HealthAffairs.org.

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Should Health Care Systems Become Insurers?

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A new article published in the Journal of the American Medical Association (JAMA) asks the question: Should Health Care Systems Become Insurers?

An introduction to the article explains that incentives under the Affordable Care Act (ACA) are spurring increasing numbers of health care systems to assume the risk of paying for patient care, blurring the boundaries between care delivery organizations and insurers. New arrangements such as bundled payments, value-based purchasing, and accountable care organizations (ACOs) transfer financial risk from payers to health care systems. The union of payer and care delivery functions may engender opportunities for health systems to invest in prevention and more comprehensive, coordinated, patient-centered care.

The entire article is available at JAMANetwork.com and is available to registered members.

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