In central Pennsylvania, Capital BlueCross and PinnacleHealth recently announced an accountable care arrangement (ACA), that officials with both organizations say is similar in design to the Medicare-based accountable care organizations (ACOs) being promoted by the Centers for Medicare & Medicaid Services (CMS).
According to Chris Markley, senior vice president of strategic services for PinnacleHealth, one of the main reasons his organization decided to join with Capital BlueCross in this venture is because Capital BlueCross has been very flexible. "They came in with the mindset of 'Let's sit down with a blank sheet of paper and figure this out.' They didn't have a cookie cutter model in mind, and consequently we had a lot of input into structuring" the new relationship.
Over at Capital BlueCross, Christopher Rumpf, MD, senior vice president and chief medical officer, said there are just two basic attributes his organization is looking for as they work to develop ACA-type relationships.
First, "there has to be a willingness to engage in this kind of work, which is new and different for most providers." The only other requirement is that the provider can't be in the middle of installing an electronic medical record (EMR) system, which, he said, "would put too much stress on the providers."
Both men said the core of their organizations' new relationship will revolve around information sharing that will enable Pinnacle's 93 physicians to have a more comprehensive view of the 25,000 Capital BlueCross patients they're treating.
As Rumpf put it, "Pinnacle's EMR system has data analytics capabilities that we don't have, and our contribution is claims data that they don't have." He pointed out that patients often see a number of providers, and any single one of them may not have all the treatment history data they could use in order to develop a full understanding of the patient's condition.
On a larger level, Markley said the new relationship will allow the partners to combine data sets that "will give a more complete look at the financial and clinical processes" involved in caring for the patients that will be covered by the new arrangement.
Regardless of the different name, the new PinnacleHealth-Capital BlueCross partnership boils down to essentially the same thing, with the same goals, as an ACO. In an article last winter in the New England Journal of Medicine, then-CMS administrator Donald Berwick, MD, wrote "Whether provided through ACOs or an alternative innovation opportunity, coordinated care is meant to allow providers to break away from the tyranny of the 15-minute visit, instill a renewed sense of collegiality, and return to the type of medicine that patients and families want. For patients, coordinated care means more 'quality time' with their physician and care team . . . and more collaboration in leading a healthy life."
As an example of how more coordinated care can benefit patients, Capital BlueCross' Rumpf pointed to the opportunity to "engage in joint care around high-risk patients, especially those with chronic diseases." For example, a patient with high blood pressure may not know how to use a home monitor. Both PinnacleHealth and Capital BlueCross have care coordinators who can teach patients how to use the monitors and then bring the results into the provider at the next visit.
As to how the alliance will measure its progress, both men say a joint steering committee will set yearly goals for the course of the five-year arrangement, and Rumpf said preliminary metrics have already been set in categories such as quality of care, patient satisfaction and care transition.
And while this may be one of the first ACAs in the central Pennsylvania region, Rumpf said Capital BlueCross is "in discussion with lots of other physician groups and hospitals systems" that are interested in developing similar arrangements.