Blue Cross and Blue Shield of Illinois

 

 

May 31, 2013

BCBSIL and OSF HealthCare Creating Accountable Care Organization
Goal to improve quality of care and reduce costs

Blue Cross and Blue Shield of Illinois (BCBSIL) and OSF HealthCare, a system owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Illinois, recently announced their intent to form a new, strategic alliance – an Accountable Care Organization (ACO). The two organizations aim to deliver improved patient care, while also focusing on the overall cost of health care.

OSF is one of the largest health care systems in Illinois, serving more than 3.5 million people.  This will be the first commercial ACO for OSF. It is also one of the 32 organizations selected by the Centers for Medicare & Medicaid Services (CMS) to participate in the Pioneer ACO pilot with the federal government. 

By providing financial incentives designed to improve quality outcomes and patient satisfaction, the ACO intends to transform the way physicians and hospitals coordinate and deliver patient care. The new ACO will see health care providers realign their focus from fee-for-service volume to a value approach for services. At the same time, incentives are structured to focus on delivering more services to the patients in greatest need to avoid the consequences of unmanaged or poorly managed disease.

For example, the ACO will have systems and processes in place to proactively identify those members with chronic disease. Programs will be available to help people better manage their health to reduce unnecessary hospital admissions and ER visits, costly readmissions, and duplication of services. As evidenced in other ACO arrangements, such attention has led to greatly increased patient satisfaction and has the possibility to make health care more affordable.

Set to begin Jan. 1, 2014, the ACO will cover nearly 40,000 OSF patients and BCBSIL members. The ACO will apply to the BCBSIL commercial fully insured and self-insured populations in the Pontiac, Bloomington, Galesburg, Peoria and Rockford areas.

The partnership represents BCBSIL’s continued commitment to embracing and fostering value-based care delivery models like ACOs and its Intensive Medical Home model.

All are designed to reward physicians for focusing on managing costs and quality simultaneously, and are intended to move the health care system from its traditional fee-for-service volume approach to a fee-for-value payment model.

This new ACO model of health care delivery is designed to improve outcomes in three key categories: quality of care, patient experience and satisfaction, and cost efficiency. To achieve these goals, the ACO will pursue the following strategies:

  • Identify early disease and illness through effective management and coordination of patient care
  • Use advanced technology and support services to make more informed decisions and foster the patient-physician relationship, as well as transitions in care
  • Implement an alternative, non-fee-for-service payment arrangement
  • Lower the cost trend through better coordination between the payer and provider, without limiting medically necessary services.

"This agreement is significant,” says Opella Ernest, MD, BCBSIL’s vice president and chief medical officer. "We’ll take better advantage of clinical data between our two organizations to assist in wise medical care decision-making and improve patient safety.”

 

 
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