Illinois' largest health insurer is building out its accountable care network, even as some of the health system partners are consolidating.
Blue Cross and Blue Shield of Illinois, the flagship insurer in the Health Care Services Corp. family, has inked four new accountable care contracts with four different providers.
About 111,000 of BCBSIL's 7 million members will be covered across the new ACOs, with the Kane County Independent Physician Association, North Shore University Health System, Presence Health and Alexian Brothers Health System. Last year, BCBSIL set a goal of having more than 800,000 members covered under accountable care networks.
"We work with each provider to better coordinate care and share valuable data that helps direct providers' efforts toward where the data trends point," said Jerry Bradford, BCBSIL's vice president for network management. "Each provider group then agrees on a set of quality measurements and improvement goals, including reducing inpatient stays and emergency room visits, avoiding unnecessary readmissions, along with improving key care quality measurements." The four new ACOs are serving mostly greater Chicago and its collar counties, as well as the Champaign-Urbana region, where Presence Health, the state's largest Catholic health system, has two medical centers. With these deals, BCBSIL now has nine ACOs.
The new crop of ACOs includes BCBSIL's second independent physicians group, the 78-doctor Kane County IPA serving some 7,000 patients from a population of 515,000 west of Chicago.
"This collaboration with BCBSIL provides a mechanism to support and maintain the independent physicians in our community," said Jose Trevino, MD, president of the IPA and a general practitioner. "In this day with increasing demands from the marketplace with downward pressure on reimbursements, we hope to provide a haven for these independent physicians as we compete with bigger, better funded health systems."
Those bigger health systems include others in BCBSIL's ACO network--adding to a collaborative and competitive dynamic with hospital systems in various states of consolidation.
BCBSIL's collaboration with North Shore University Health System spans some 62,000 patients served by 255 primary care physicians, and the insurer's largest ACO contract to date is with North Shore's soon-to-be partner in a merger, Advocate Health Care. If the merger is approved by the Federal Trade Commission, it will be the largest health system in both Illinois and Chicagoland.
The Advocate ACO, covering 250,000 BCBSIL members, is the nation's largest commercial ACO, and is now in its fifth year. In its first three years, BCBSIL said the ACO's cost trend was six percent lower than the rest of the insurer's PPO population and also was associated with lower readmission rates.
Another one of BCBSIL's new ACO partners, the five hospital Alexian Brothers Health System, a part of Ascension, the country's largest non-profit health system, is also in the midst of entering into a joint operating affiliation with Adventist Midwest Health, a division of Adventist Health System, which is also one of the largest faith-based health systems in the country. The new inegrated health system, the state's third largest, is called AMITA Health, including nine hospitals and 3,000 physicians serving the west and northwest suburbs of Chicago.
It's an ACO deal with a health system that is a part of a larger health system and in a joint operating agreement with another health system that is also part of a larger health system--a web of organizational structures that nonetheless offers an opportunity for BCBSIL's value-based contracting strategy.
"This ACO is the first such effort with a private insurer for Alexian Brothers Health System," said Don Franke, vice president for clinical integration at the health system. Franke said Alexian will be taking "lessons it learned" from its Medicare Shared Savings ACO and apply them to the 14,000 BCBSIL members in the new ACO. "That includes considering issues at home that might impact patients' health, such as not having transportation to get to a doctor," he said.
Meanwhile, Presence Health, which has a base in greater Chicago, is creating an ACO with BCBSIL to try to address the palpable healthcare concerns of Illinoisans.
"One of the things we're hearing from people who pay for healthcare, whether that's employers or the government, is that the cost of care is too high and the quality doesn't seem to support the cost of care," said David DiLoreto, MD, chief clinical officer of Presence Health Partners, the health system's network of 2,500 affiliated physicians.