Hub and Spoke ACOs May be Hard Sell In U.S.

A post today on describes a new alliance in western Pennsylvania between Highmark Health Services and six Allegheny Health Network (AHN) hospitals as being “like an ACO without walls.”

The article, which was reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, reported that this alliance is part of Highmark’s effort to accelerate the shift from volume-based, fee-for-service (FFS) payment to a system that pays for value.

Highmark describes the alliance, in this article, as a way to foster more integrated care, moving beyond primary care physicians (PCPs) in its Patient-Centered Medical Home (PCMH) program to add specialists and hospitals to the mix. Continue reading

Cigna Starts Accountable Care Plan in San Franciso Bay Area

SAN JOSE, Calif., October 14, 2013 – Cigna (NYSE: CI) and Santa Clara County IPA (SCCIPA) have launched a collaborative accountable care initiative to improve patient access to health care, enhance care coordination, and achieve the “triple aim” of improved health, affordability and patient experience. The program became effective October 1, and is Cigna’s third accountable care initiative in the San Francisco Bay Area.

According to a company announcement, collaborative accountable care is Cigna’s approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program will benefit more than 13,000 individuals covered by a Cigna PPO health plan who receive care from SCCIPA’s 850 primary care doctors and specialists.

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Aetna and Sharp HealthCare Expand Accountable Care

SAN DIEGO–(BUSINESS WIRE)–Aetna announced an accountable care collaboration and the introduction of Aetna Whole HealthSM, a new commercial health care product that provides members access to highly coordinated care from physicians and facilities in the Sharp HealthCare system. The new product, effective February 1, will be available to self-insured and fully insured businesses with greater than 100 employees who reside in San Diego County.

An accountable care collaboration is a group of health care providers who assume responsibility for the quality and cost of care for a group of patients. Aetna members will receive an enhanced level of coordinated care in addition to the member benefits of their current Aetna plan.

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Coventry Health Care of Illinois and SwedishAmerican Health System Collaborate to Form High-Performance Network

ROCKFORD, Ill.–(BUSINESS WIRE)- Coventry Health Care of Illinois, Inc. and SwedishAmerican Health System have announced the formation of a new high-performance network in Rockford, IL. A new product, Carelink from Coventry: A SwedishAmerican Partnership, became effective September 1, 2013, with the goal of improving quality of care and lowering overall health care costs.

A high-performance network collaboration is a group of health care providers who assume responsibility for the quality and cost of care for a group of patients.

Coventry is working with health care organizations throughout the state to develop products and services that support value-driven, patient-centered care.

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Payment Incentives Can Boost Care, but Long-Term Strategies Needed Acording to a new JAMA Study

Financial incentives can encourage physicians to provide higher quality care to their patients, but the additional money might not be enough to significantly improve care over the long term, according to a study published Wednesday in the Journal of the American Medical Association, the Los Angeles Times‘ “Science Now” reports.

The study found that the individual incentives — $2,672 per doctor on average — helped spur a significant change in the physicians’ performance. Meanwhile, group payments — $1,648 on average — and combined group and individual payments — $4,270 on average — did not lead to significant changes in performance (Evans, Modern Healthcare, 9/11).

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Study Reveals Risk for Market Disruption with Move to Value-Based Care

JACKSONVILLE, Fla.–(BUSINESS WIRE)–Health plans and providers expect their participation in value-based care programs to more than triple in the next three to five years. For that growth to be successful, more than 90% of respondents from both groups agree they must automate the information exchange required by these programs. However, only a small percentage of providers and plans report having fully-automated capabilities in place – leaving a questionable gap in the current operational readiness of the market.

These findings and others are from a pair of recently-published research studies by Availity, a leading health information network. They shed further light on the need for automated information exchange solutions in the market to support emerging payment models, and call attention to the disruption the market may encounter if health plans and providers continue to rely on manual methods of exchanging critical data.

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University of Utah Health Plan Launches Accountable Care Program with Value Based Payments to Providers

Salt Lake City, UT – Officials at University of Utah Health Plans (UUHP) have unveiled the Accountable Care Program, which will serve 56,000 members in Utah. The new program includes a partnership for value based payments between the health plan and the University of Utah Primary Care Physicians Group and is the first Medicaid ACO plan to accomplish this in Utah.

As part of the program, University physicians will monitor and coordinate all aspects of an individual’s medical care. This means patients with chronic conditions like diabetes will see one provider who will coordinate all that patient’s needs, such as diabetes care, eye care, and skin care.

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Patient-Centric Quality Measures Are Needed for True ACO Ratings

ACOs and payers should weave much more specific, function-oriented patient satisfaction and patient-driven decision-making measures into the quality standards that determine reimbursement for physicians and organizations, ACO executives say.

Creating these new quality measures — and scoring well on them — will require widespread changes in health information technology (HIT) systems, physician attitudes and organizations, says Palmer Evans, M.D., former senior vice president and chief medical officer at Tucson Medical Center in Arizona and senior advisor to the South Arizona Accountable Care Organization, which includes Tucson Medical Center and more than 170 physicians.

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San Francisco Area Health Centers Seek to form ACO

A prominent group of health centers in the North Bay (San Francisco) has applied to form what is known under the new federal health law as an “accountable care organization” serving thousands of Medicare patients that, if approved, could be one of the first of its kind in the nation.

Under the ACO program by Medicare, health care providers and payers are encouraged to better coordinate care, hoping to achieve the so-called “triple aim” of improving quality of care, improving patient experience and reducing costs, officials said.

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Regence and MultiCare Health System Announce New Collaborative Care Initiatives

SEATTLE, Aug. 27, 2013 /PRNewswire/ — Regence BlueShield in Washington and MultiCare Health System today announced that they have taken an important step in advancing the Triple Aim goals of improving the health of patients and their care experience, and lowering costs, through a new payment model. Additionally, the two organizations are collaborating on innovative new networks and health insurance products to further enhance care and bend the medical cost curve for people in the south Puget Sound region.

The initiative will include a shared incentive reimbursement arrangement for services at MultiCare hospitals and clinics which will be aligned with increased focus on quality and patient care goals that are mutually agreed to by Regence and MultiCare.

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