In a remarkable example of how health care is shifting away from traditional models, three of Rhode Island’s largest medical institutions announced a formal partnership on Wednesday to collaboratively manage the care of 45,000 patients.
The agreement will bring together entities whose relations were once disjointed at best — an insurer, Blue Cross and Blue Shield of Rhode Island; a hospital network, Lifespan; and a primary care provider, Coastal Medical.
Together, with the use of electronic medical records, they will seek to systematically coordinate the care of Coastal patients. The more they are able to improve care and prevent duplication of services and costly hospitalizations and ER visits, the more they stand to keep patients healthy and share in savings.
That’s the whole idea of so-called “accountable care organizations,” which in the wake of the Affordable Care Act are being embraced as a way to curb unsustainable cost increases in health care. ACOs are now cropping up all over the country, including Rhode Island, and are involving both private and government insurers.
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“The Affordable Care Act started this tsunami of change in the industry,” said Dr. Timothy Babineau, president and CEO of Lifespan. “It’s about two things: creating new models of care supported by new payment models.”
Bringing together the state’s largest primary care practice with a hospital system that is a leader in a variety of specialties and then getting the financial backing of an insurer, “That’s the trifecta we’ve been looking for,” Babineau said.
He took part in an interview along with Peter Andruszkiewicz, president and CEO of Blue Cross and Blue Shield, and Dr. Al Kurose, president and CEO of Coastal. All three said that after years of the industry incrementally moving away from simple fee-for-service models, enthusiasm for this full-fledged program was noticeable when it was presented to the leadership of each organization during a presentation at Rhode Island Hospital on Tuesday.
This is just the beginning,” said Kurose. “We have a lot of shared learning to do now.”
When it comes to health policy, acronyms and concepts can be vague to the average person, the three health leaders acknowledged. But to the patient, it should mean “an experience that makes sense to them as they move across all the different places that they receive health care,” Kurose said.
As they move from their primary care doctor to a specialist at a hospital, “we want them to have that experience where it’s all seamless and coordinated and they know that everyone caring for them is communicating,” he said.
Coastal launched the first Medicare Shared Savings Program in Rhode Island in 2012 and last year, with about 11,000 patients in the program, was honored as among the top 1 percent in the nation. More than half of Coastal’s patients are now in such programs.
Date: March 2, 2016