Blue Cross and Blue Shield of Illinois doubles down on ACOs, partners with doctors to lower medical costs

A pediatrician and his patient
Blue Cross & Blue Shield of Illinois has almost doubled the number of accountable care organizations. (Getty/shironosov)

As the number of accountable care organizations (ACOs) continue to grow across the country, Illinois is one state that is a leader in the initiative, and Blue Cross & Blue Shield of Illinois is a big player in that effort.

The Chicago-based health insurer, which is the largest in the state with more than 4.2 million members, has almost doubled ACO partnerships with doctors and hospitals, according to Crain’s Chicago Business. About one in four members of BCBSI are now part of an ACO.

That’s part of a nationwide trend aimed at lowering medical costs, as more than 850 ACOs currently provide care to more than 28 million patients across the country. This year, 570 ACOs will participate in Centers for Medicare & Medicaid Services models.

ACOs were established under the Affordable Care Act (ACA), a law whose fate is now in doubt as the House yesterday voted on a bill to repeal and replace it. The legislation now goes before the Senate, although it has received a chilly reception there thus far.

RELATED: Can ACOs survive a repeal and replacement of the Affordable Care Act?

That raises questions about the future of ACOs, intended to improve care and reduce costs, but one leading health policy expert predicted that even if the ACA is voted out by Republican lawmakers, the model will survive. “ACOs are here to stay,” said Paul Keckley, Ph.D.

The Illinois health insurer doubled the number of ACO collaborations to 20, from 11 in 2016 and just six in 2015, according to Crain’s. New partnerships in 2017 include physician groups affiliated with Lurie Children's Hospital, University of Chicago Medicine and Northwestern Medicine, with plans to keep growing in the future.

Growing the number of ACOs has had results for BCBSI, including 16% fewer emergency department visits, 15% fewer hospital admissions and $17 less spending per patient per month, the publication said.

RELATED: 3 ways physician-led ACOs outperform hospital-led organizations

Lurie Children's Health Partners Clinically Integrated Network, a physicians group partly owned by the children’s hospital, has an ACO with BCBSI that covers about 85,000 children, and uses claims data provided by the insurer to improve care. For instance, it uses a care coordinator to reach out to parents if they see children are frequently going to the emergency room.

Participating in an ACO is a way to help doctors who want to stay independent and succeed with MACRA, the new Medicare payment system. Physician-led ACOs are showing promising results and have a number of advantages for participants, including providing a way for practices to handle increasing government regulations. 

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