Washington, DC (PRWEB) July 02, 2014
Most value-based contracts with commercial insurers still feature shared savings and rewards for higher quality, but payers are eager to evolve those agreements so that they include more risk for primary care providers, and also begin to include specialists, according to payer and provider representatives who spoke at the National Accountable Care Organization Summit. The July issue of Atlantic Information Services, Inc.’s ACO Business News offers coverage of the Global Health Care LLC-sponsored conference, held in Washington, D.C., on June 19. The speakers told attendees that value-based contracting rapidly is becoming the norm in the commercial space.
James Fawcett, senior vice president for provider contracting and relations at Highmark Blue Cross Blue Shield, said the Blues plan’s goal was to have 75% of members in pay-for-value contracts by 2016, and those contracts “must support all members and all programs.” To achieve this, Highmark has pursued some innovative payment arrangements, Fawcett said. For example, its end-stage renal disease (ESRD) program now includes shared savings contracts with major dialysis providers in Highmark’s region. “ESRD costs an average of $10,000 per member per month,” so shared savings on those patients adds up quickly, he said.
Richard Salmon, M.D., national medical director for performance measurement and improvement at Cigna Corp., told meeting attendees that Cigna has 89 Collaborative Care arrangements so far, covering more than 16,000 primary care physicians and more than 910,000 Cigna members. To be successful in the new era of accountable care, primary care physicians need to remain generalists and retain the biggest skill sets possible, while still consulting specialists where needed, Salmon said. This will enable them to better manage the care of complex patients in-house, where it’s most cost-effective, he said.
Visit http://aishealth.com/archive/nabn0714-03 to read the article in its entirety, including comments delivered by H. Scott Sarran, M.D., divisional senior vice president and chief medical officer, government programs, Health Care Service Corp., and Thomas Raskauskas, M.D., president and CEO of St. Vincent’s Health Partners, Inc., in Bridgeport, Conn.
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ACO Business News delivers timely news and business strategies on accountable care organizations for physicians and provider groups, hospitals, health plans and their advisers. The monthly newsletter covers the latest industry actions to design and create ACOs, results that are already being achieved by ACO-like entities, and HHS regulations and guidance on this provocative new trend in health care. Featuring the pros and cons of various strategies for different types of organizations, ACO Business News is designed to help readers avoid the pitfalls ahead and transform exciting ACO opportunities into winning business strategies. Visit http://aishealth.com/marketplace/aco-business-news for more information.
About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.