'Largest commercial ACO' earns early results

With only six months of data, the largest hospital system in Illinois, Advocate Health Care, and major health insurer Blue Cross Blue Shield of Illinois (BCBSIL) are declaring some early successes with its provider-payer accountable care organization, which is the largest commercial ACO, Scott Sarran, BCBSIL's chief medical officer, said in a Kaiser Health News article.

Advocate Health Care based in Chicago and BLBSIL's ACO called AdvocateCare has 250,000 PPO members and 125,000 HMO members, according to Sarran. In its first six months of 2011, the ACO resulted in hospital admissions per member dropping 10.6 percent, compared to 2010, and emergency department visits decreasing 5.4 percent, Kaiser Health News reported.

AdvocateCare Vice President Lois Elia said in the article, "It's clear we're driving down utilization." She cited 60 case managers who work with high-risk and post-acute cases as one of the drivers of the promising results.

"This is good but too early to draw conclusions," Elia said. However, she continued, "we get calls weekly from people that want to understand what we're doing and the value it's creating and how we're going about it."

In 2010, the two parties agreed to the ACO. Even though the federal government offers under the 2010 health reform law a platform for Medicare ACOs, providers and payers have joined forces to create their own ACOs outside of the Medicare Shared Savings Program. For example, Hoag Memorial Hospital Presbyterian, Blue Shield of California and Greater Newport Physicians IPA just weeks ago announced its intent to create an accountable care initiative, and Pioneer ACO Atrius Health recently hinted in a FierceHealthcare interview that it is considering partnerships with commercial insurers, having already begun talks in reducing costs.

"If we're doing this in the Medicare arena, why can't we do this in the commercial environment, as well, and then be rewarded for the benefit we bring to the reduction in total expenses in Medicare PPO patients?" Atrius Health President and CEO Gene Lindsey said.

"Before, we were limited to the fee-for-service revenue that would be associated with caring for those patients. So this opens up a whole new vista in healthcare finance when we are looking for new ways to fully fund the programs of care that we want to offer," he said.

For more information:
- read the Kaiser Health News article
- read the FierceHealthcare interview with Atrius Health

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