Plan-Provider Partnerships Improve Health Care Cost And Quality

posted by Alicia Caramenico

on June 23, 2016

Blue Shield of California is no stranger to using accountable care models to reduce health care costs and deliver effective, evidence-based, personalized patient care.

After launching its first ACO in 2010, the health plan now has more than 36 ACOs in California, serving more than 340,000 members. These ACOs are partnerships between the health plan, hospitals, and doctors that break down silos, build trust, optimize costs, and improve health outcomes for patients.

Blue Shield has identified critical ACO success factors to change how Californians pay for and receive health care. So far its ACO program has reduced hospital admissions by 13 percent and decreased patient hospital stays by 27 percent. In total, these changes have generated health care cost savings of more than $395 million.

Take for example Blue Shield’s ACO with Brown & Toland Medical Group in the San Francisco area. With support from Blue Shield, Brown & Toland Medical Group opened two “after hours” clinics, enhanced the functionality of its patient advice line, and expanded its transitions of care coordination to include commercial members along with Medicare Advantage beneficiaries. As a result of these efforts and more, the ACO with Brown & Toland Medical Group has seen improvements related to length of stay, transitions of care, pharmacy costs, and alternatives to emergency room use.

To see other examples of health plans’ payment and delivery system reforms, click here.

 Note: This content was based on presentations at the AHIP Payment Reform Summit in October 2015.