A newer Kansas-based accountable care organization will expand through a partnership with Blue Cross and Blue Shield of Kansas, which serves 23,000 in-state patients.
Aledade Inc. is a Bethseda, Md., private health care consulting company that operates accountable care organizations throughout the U.S. One of its newest additions, the Aledade Kansas ACO, launched in January to support independent primary-care practices.
ACOs, as defined by the Centers for Medicare and Medicaid Services, consist of health care providers that voluntarily group together to better coordinate patient care and subsequently reduce health care costs. The Affordable Care Act was the genesis for the model’s adoption.
For example, Aledade Kansas is helping 13 small primary-care practices throughout the state meet value-based care requirements for 11,000 Medicare patients. In turn, Medicare offers value-based incentives to those ACO members.
BCBS of Kansas, which already had started offering value-based contracts to hospital-affiliated ACOs, will begin offering similar incentives to Aledade Kansas ACO members, starting Jan. 1.
“Moving into the value-based role is really a direction most, if not all providers are going to have to take,” said Erin Patrick, ACO executive director for Aledade Kansas. “Over the past nine months, we’ve worked diligently under a variety of initiatives. We’ve really laid that groundwork, and now it’s time to start building a house.”
As ACOs gain a reputation for success, more providers and insurers are working out agreements to replicate the ACO model in the private insurance market.
“It’s moving the provider reimbursement model away from a fee-for-service model and taking the steps toward a quality-over-quantity reimbursement system,” said Mary Beth Chambers, corporate communications manager for BCBS of Kansas. “This really helps because in Kansas there are so many solo- or two-practitioner offices in many of our smaller or more rural areas.”
Although BCBS of Kansas has worked with a handful of hospital-affiliated ACOs statewide, the new agreement with Aledade will support doctors in rural areas. Aledade Kansas serves practices from Western Kansas towns like Quinter to two family practices in Lawrence and one in Lansing.
Aledade Kansas plans to add three additional practices next year. The ACO serves one family practice in the Kansas City area but otherwise primarily works with rural doctors.
“We truly do span the entire state of Kansas,” Patrick said. “We would love to expand in the Wichita, Topeka and Kansas City areas. What we find, though, is a lot of those practices are not independently owned.”
The relationship among ACOs, doctors and private insurers
The Aledade Kansas ACO provides technical and regulatory guidance to independent practices within the organization, including face-to-face meetings with specialists who have a background in topics ranging from nursing to IT to health care administration. The company also offers a patient database to track screenings and trends and to manage chronic conditions more efficiently.
Through the new agreement, BCBS will provide Aledade Kansas additional data, which will be distributed to the individual practices as needed.
“Part of an ACO arrangement is access to data in terms of trends within a practice or a patient registry, to keep track of patients attributed to that provider, who has what chronic conditions, who’s gotten their A1C tested, all that sort of data,” Chambers said. “That is one of the things (practices) will have better access to through this partnership.”
In the long term, the goal is to reduce costs by avoiding unnecessary duplication of tests, as well as helping practices report metrics of success for value-based care.
“We very much believe our providers already provide quality care. There are just some details we have to work through and make sure they’re getting credit for what they’re doing,” Patrick said. “I think this is going to give our providers a leg up in a more comprehensive perspective for their patients, moving beyond Medicare patient panel.”
Date: November 30, 2016