Kansas’ Largest Insurer And Health Care Provider Agree To New Payment Model
Kansas’ largest health insurer and the state’s largest health care provider are forming an accountable care organization to lower health care costs.
After nearly a year of negotiations, Blue Cross and Blue Shield of Kansas and Wichita-based Via Christi Health have finalized an agreement aimed at changing the way care is provided to approximately 20,000 Kansans covered by BCBS policies.
Under the agreement, Via Christi would share in any savings that result from an emphasis on preventive care and from more effective management of patients with chronic conditions. But it could also lose money if the anticipated savings don’t materialize.
The arrangement creates financial incentives to move away from doing tests and procedures that inflate health care costs without improving the quality of care, says Mary Beth Chambers, a spokesperson for BCBS of Kansas.
“It really creates kind of a new type of partnership between the insurer and the health care provider,” Chambers says.
The belief — buttressed by research — that an increased focus on preventive care and management of chronic conditions can lower overall health care costs has led networks of doctors and hospitals across the country to form hundreds of accountable care organizations, or ACOs.
Providers in ACOs receive what amounts to a flat fee to provide all the care their patients need. Because health outcomes also are monitored, providers have strong incentives to focus on delivering cost-effective care without cutting corners that could jeopardize the health of their patients.
The agreement with BCBS is the latest indication of Via Christi’s strategic direction.
Three years ago, it created the Healthier You Alliance in Accountable Care, which utilizes a network of more than 600 providers to coordinate care for 21,700 Medicare beneficiaries in Wichita, Manhattan and Wamego and approximately 16,0000 Via Christi employees and their dependents.
Three years ago, Via Christi created its Healthier You Alliance in Accountable Care. Under the alliance, a network of more than 600 providers coordinate care for 21,700 Medicare beneficiaries in Wichita, Manhattan and Wamego and approximately 16,000 Via Christi employees and their dependents.
Dave Gambino, chief strategy officer for Via Christi, says the Healthier You Alliance set the stage for the agreement with BCBS of Kansas.
“What makes our ACO unique in our service area is that it’s a physician-led payer-provider model,” Gambino says. “Working together allows us to create wins for everyone involved.”
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.