Blue Cross Blue Shield of Texas Creates New Accountable Care Organization Alliance

Richardson-based Blue Cross and Blue Shield of Texas announced a new strategic alliance Thursday that it hopes will deliver improved, sustainable patient care while better managing healthcare costs, beginning in mid-2014.

The partnership—with Memorial Hermann Accountable Care Organization—is aiming to improve patients’ health while reducing costs through avoiding unnecessary hospital admissions, readmissions, emergency room visits, and duplication of services.

“This is a paradigm shift in paying for medical services,” Shara McClure, BCBSTX vice president for network management, said in a statement. ”The arrangement begins to move reimbursement away from fee for service to fee for value. In addition, the arrangement enables MHACO to harness clinical data to help drive medical care decision-making, enhance patient safety, and improve quality of care—all supporting the goals of better health and improved outcomes for BCBSTX members.”

The ACO model of healthcare delivery is designed to improve outcomes in three  categories: quality of care, patient experience and satisfaction, and cost efficiency. BlueCross will reach those goals by pursuing:

— Early identification of disease and illness through coordination of patient care

— Use of advanced technology and support services to make more informed decisions and facilitate transitions in care

— the implementation of an alternative or non-fee-for-service payment arrangement

— lower cost trends by increasing coordination among payers and providers

“Our relationship with Blue Cross Blue Shield of Texas around accountable care activities is consistent with Memorial Hermann’s commitment to quality outcomes and cost management,” said Chris Lloyd, CEO of MHACO. “The efforts we will undertake together will continue to advance the health of the populations we serve.”

BCBSTX is entering the ACO game just as another prominent North Texas healthcare organization is leaving it. Plus ACO—the accountable care organization comprised of Texas Health Resources and North Texas Specialty Physician— indicated to CMS in July that it intended to withdraw from the Pioneer ACO program, due to unmet financial goals.

“We look forward to working with CMS in other areas, and we will continue to support the accountable care framework’s fundamental components—reducing costs, improving patient outcomes through enhanced quality of care and care coordination across the continuum,” THR spokesman Wendell Watson said in an email to D Healthcare Daily in July.

Watson said Plus ACO was on track to save $10 million annually, yet was anticipating that it could be liable for a penalty between $6 million and $9 million at the end of the year. Watson said the group will continue to work with commercial plans to implement accountable care programs.

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