California Blues CEO Shares ACO Success Factors

by Alicia Caramencio

May 17, 2016

Accountable care organizations (ACO) are one type of payment reform model that improves the coordination and quality of care for patients by tying reimbursement to quality and reduction of cost in providing care. Health plans across the country have been partnering with doctors, hospitals, and other providers in ACOs of all shapes and sizes. To change how Californians pay for and receive health care, Blue Shield of California has created more than 35 ACOs covering more than 325,000 patients across the state.

While no two ACOs look alike, they all share critical success factors, Blue Shield of California CEO Paul Markovich recently told Managed Healthcare Executive in an interview. “Our growth can be attributed to the sustained success of the model and our ability to trace that success back to the ‘will’ and ‘skill’ we have created,” he said.

Will: ACOs use a shared risk financial mechanism and specific cost and quality goals, and this motivates hospitals and physician groups to adjust their processes to keep patients out of the hospital, Markovich explained.

Skill: Blue Shield of California has a large team solely dedicated to operating the ACOs. The team works with each ACO partner to develop and track performance against specific performance goals and to provide recommendations for additional benchmarks and initiatives.

Commitment: Markovich noted that Blue Shield of California has focused on integrating program management technique, data analytics, clinical resources, pharmacy program management, and more to its ACOs.

Using ACOs to achieve the Triple Aim of lower costs, improved clinical quality, and a better patient experience is a priority for Blue Shield of California. It’s committed to the principles of accountable care to create a high-quality, affordable, and sustainable health care system.