JACKSONVILLE, FL – Health insurer Florida Blue has teamed up with Miami-area providers Baptist Health South Florida and American Medical Specialties (AMS) to launch an accountable care organization (ACO) that will focus only on oncology treatment.
The new ACO will leverage the expertise of Baptist Health and the 17 facilities run by AMS to provide treatment for the top diagnostic categories that comprise roughly 85 percent of oncology diagnoses. These include: gynecological, male reproductive, breast, colon, lung and hematologic/lymphatic cancers.
"Oncology costs have been accelerating faster than almost any other cost in the healthcare market," said Jonathan Gavras, MD, chief medical officer and senior vice president, delivery system for Florida Blue. "We knew we had to find an alternative to fee-for-service delivery that was focused much more on quality of outcomes and integration of healthcare. The three of us decided to do something different. This has been done in other specialties for larger ACOs, but oncology is something that there really hasn't been a lot of experience in."
Like most ACOs, the major agreements to create the collaboration revolve around creating a new payment model and the sharing of data and transparency of data.
For the contract, Florida Blue left existing agreements with the two providers in place and for the care related to the ACO created a separate shared savings structure, Gavras said.
For the necessary data, Florida Blue has agreed to provide Baptist Health and AMS with member data and analytics that will help determine the course of treatment. It's a level of sharing that hasn't always occurred between a health plan and providers.
"There is an undeniable level of trust required as part of these tripartite arrangements because hospitals and physicians do not have access to the same level of data as the insurer," said Ralph Lawson, executive vice president and CFO of Baptist Health South Florida.
Based on the facilities participating and past cancer incidence among its members, the parties in the new ACO anticipate treating between 500 and 1,000 Florida Blue members over the first year of the pact. The plan is to use existing and well-recognized treatment pathways for oncology as the basis for treatments and improving upon them as their data suggests.
In addition, Gavras said there is ample opportunity to provide better care and create savings by better educating patients on the nature of their disease as well as better coordination of care.
"A large issue is that people don't fully understand their condition or (understand) their options through the therapy protocol," he said.
According to Leonard Kalman, MD, chairman of AMS, the focus of its 17 oncology practices in the Dade County has been to use evidence-based treatment regimens, care planning and methods to reduce both ER visits and avoidable hospital readmissions. While AMS' structure will ease the transition to the new care and payment model, it is truly a three-way partnership.
"We are all investing in this," Gavras noted. "We are going to work all three of us together in an effort to improve our clinical protocols and pathways."