Blue Cross Blue Shield ACO reduces hospital, ER visits

The accountable care organization formed between Blue Cross Blue Shield of Illinois (BCBSIL) and Advocate Health, called AdvocateCare, has reduced spending significantly in only its first six months of operations, Kaiser Health News reported. "It's clear we're driving down utilization," AdvocateCare Vice President Lois Elia said. The ACO has reduced hospital admissions per member by 10.6 percent and decreased emergency department visits by 5.4 percent. "The economy impacted some of this," Elia told KHN. "But since our medical cost trend was 6.1 percent below market, it shows our reductions were likely due to prevention of ambulatory-sensitive conditions through better care management, physician access and the like." These cost savings are primarily a result of 60 care managers who oversee high-risk cases and post-acute care, as well as a narrow provider network and a payment system that incentivizes Advocate to contain costs. However, Elia recognized that six months isn't enough time to ensure long-term success. "This is good but too early to draw conclusions," she said. Article