As the industry moves from fee-for-service toward collaboration, quality and payment reform, insurers including Independence Blue Cross (IBC) have been preparing their communities for the transformation with new care models, Rich Snyder, IBC's chief medical officer, said Thursday in a roundtable discussion at the New Health Insurance Business Models in Washington, D.C.
To start driving this change, the Philadelphia-based insurer launched a medical home pilot four years ago, with goals to drive down utilization and costs. A key component of the new care model was reinforcing primary care, in which IBC paid extra to primary care physicians to transform their practices into medical homes, as well as doubled the incentives they could earn, Snyder noted. Such incentives led to more than one-third of IBC members using medical homes.
The current medical home model is a great start to achieving accountable care on a larger scale, added Thomas Lundquist, chief clinical integration officer at Mountain States Health Alliance's Integrated Solutions Health Network in Tennessee.
"An ACO in its purest sense is made up of a bunch of well-functioning medical homes and primary care offices," he said.
But to really reach "triple aim" goals of improved health outcomes, lower costs and better patient experience, Lundquist noted that accountable care organizations must involve hospitals and specialists, as well.
Building upon the medical home model, IBC created ACOs to move its community further into the era of coordinated, accountable care, Snyder noted. The insurer's ACO success centered on performance-based payment to incentivize hospitals to better manage patients' health and bend the cost curve.
"Pay the guys that are actually going to change the way healthcare is practiced," he said.
With that in mind, the average community hospital went from $5 million incentives up to $40 million with an ACO-type arrangement with IBC.
"Pay the guys that are actually going to change the way healthcare is practiced."
Although incentives make medical homes and ACOs attractive care models, providers still need a lot of support to implement them. Insurers must offer advanced technology and robust data to participating providers. For instance, IBC uses a data-harvesting tool to aggregate clinical data, claims data, lab results and pharmaceutical data so it can then give providers a full picture of patients.
Such data analytics are vital to accountable care success, FierceHealthPayer recently reported. Because providers usually ask for health plan data, providers must understand how the data is mapped, what it means, as well as determine how they will integrate that data with their own information.