Almost gone are the fee-for-service reimbursement days, where physicians were reimbursed only for the volume of care - these days, physician reimbursement has shifted to focus on quality and cost. In 2010, Blue Cross and Blue Shield of Illinois (BCBSIL) and the physicians at Advocate Health System launched the first commercial Accountable Care Organization (ACO) in Illinois. Since then, BCBSIL has been a leader in the development of value-based care and has evolved and expanded its ACO program, with partners who have committed to creating innovative programs that improve member access, improve quality of care and control costs in a sustainable way. BCBSIL’s latest advances are in the area of specialty ACOs - including the first ever Endocrinology ACO.
Transitioning from fee-for-service to a risk-based arrangement requires a paradigm shift for the providers and the payer. Part of that shift is accomplished through technological advancements and patient transparency improvements. In this presentation, Lee McGrath, Divisional VP of Network Strategy & Innovation at Blue Cross and Blue Shield of Illinois will examine the impact of ACO contracts from the payer side. The event will provide an overview of the past, present and future of ACO arrangements and contracts. It will also examine the role technology plays in supporting an ACO and what factors a payer considers when evaluating third-party solutions.
Lee McGrath is the Divisional Vice President of Network Strategy and Innovation at Blue Cross Blue Shield of Illinois. In this role she is responsible for developing and managing innovative value-based models with providers and hospital partners as well as provider relations for both hospitals and physicians. Prior to this role she was President of Illinois Health Partners (IHP), a joint venture between DuPage Medical Group and Edward Health Ventures setting the strategy and direction of one the largest clinically integrated networks in the Chicagoland area managing over 250,000 HMO and ACO patients.
This program is a part of MATTER's Healthcare Management Immersion Series.
The current fee-for-service model in healthcare is gradually fading as payers continue to focus on keeping costs low in a model where providers are incentivized on quantity over quality of care. Risk-based contracting flips the incentive, where providers profit when patients are healthier and do not require as many hospitalizations. Large health plans have made significant inroads into risk-based contracting: The new Health Care Transformation Task Force of providers, insurers, and employers has committed to shift 75% of its members into contracts with incentives for health outcomes, quality and cost management by January 2020.
Standard fee-for-service contracts have historically existed between insurers and health systems in the form of PPOs and HMOs, as has the contracts between these hospitals and specialists, primary care providers, and medical groups. Under value-based care, these contracts are being refined to drive more accountability onto health systems, but additional contracts between payers and pharmaceutical and medical device manufacturers are also bringing the full promise of value-based care forward.
MATTER seeks to convene entrepreneurial and industry innovators to pursue both technological and business model/ process solutions that enhance the translation, packaging, and efficient delivery of healthcare management.