Payers, providers collaborate in triple-aim approach, P4P

Two health insurers--HealthPartners and Blue Cross Blue Shield of Michigan--have focused their attention on collaborating with providers to improve health outcomes.

One key to successful payer-provider partnerships is to "collaborate broadly, genuinely and tenaciously," Patrick Courneya, HealthPartners' health plan medical director, said Friday at the AHIP Institute in Salt Lake City.

Quality should be another focus of collaborations, Courneya said, adding that payers should use quality as a lead-in for conversations with providers.

"Quality is the foundation as the conversation moves toward the triple aim" of enhancing the care experience, improving patient health and decreasing costs, he explained.

The Minnesota-based insurer has launched several collaborative projects with providers successfully throughout the state, according to Courneya. Its depression management program, which uses many of the principles inherent in patient-centered medical homes and accountable care organizations, is one such example. It involves a collaborative approach to taking care of patients with depression, including a care manager, primary care physician and psychiatrist, to manage patients with depression.

"The outcomes have been great--five to 10 times better than the usual primary care results," Courneya said. The program has more than 2,400 patients, 43 percent of whom are now in remission, and 17 percent have had at least 50 percent reduction in severity, he added.

Meanwhile, Blue Cross Blue Shield of Michigan "envisions a high-quality healthcare system where providers and hospitals are the champions of change," Marc Keshishian, senior vice president and chief medical officer for Blue Cross's Blue Care Network, told AHIP Institute attendees.

That's why the insurer launched a physician group incentive program that encourages doctors to join group organizations and uses varying initiatives to reward the groups' performance. Since one- to two-doctor practices are common throughout the state, Blue Cross provided resources for those small practices to form groups of 10 to 15 practices to fund the infrastructure so they could participate in the program. 

To reward performance, Blue Cross established a reward pool, which is funded through a percentage contribution of all professional payments. That pool currently stands at almost $110 million each year, Keshishian said. What's more, the program has grown from only 10 physician organizations in 2005 to 40 organizations in 2012, including about 67 percent of primary care physicians and 44 percent of specialists throughout the state.

Looking forward, Blue Cross said it hopes to continue its collaborative efforts with providers in the state.

"We want to develop new initiatives every year to engage the provider community, increase the number of physician participation in future programs and support and disseminate research results," Keshishian added.