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The ACO Path Forward

BY STUART LEVINE – Today, Blue Shield of California announced that in the first five years of our Accountable Care Organization (ACO) program, we have achieved more than $325 million in healthcare cost savings. My Blue Shield colleague Kristen Miranda, senior vice president of Strategic Partnership & Innovation shared this news at the Milken Institute’s 2015 California Summit in Los Angeles.

We’ve come a long way since we launched our first ACO in 2010 in Sacramento. We now have 35 ACO collaborations serving communities across California, and we continue to draw enthusiastic interest from physicians and hospitals throughout the state.

Our ACO cost savings were achieved through collaborative work with our network providers to help deliver the right care at the right time and at the right setting. That effort has resulted, in part, in fewer hospital admissions – up to 13 percent reduction – and also decreases in hospital bed days – up to 27 percent.

As we focus on our path forward for the next five years, we are building upon what we’ve learned and accomplished since 2010, and the strong foundation of trust and transparency we’ve established with our provider affiliates. The principle of our ACO program is based on the quadruple aim: increased patient satisfaction and engagement, lower total cost of care, improved quality of care and provider satisfaction. We’ve accomplished this by developing a comprehensive integrated care delivery system without walls.

Our vision is to help physicians, nurse practitioners, care managers and others evolve into specialized teams of providers caring for patients with the most challenging needs. This approach would give primary care doctors more time and use specialists for consultation and collaboration. This innovative healthcare delivery strategy will meet patients where they are.

We will do this through a patient-defined medical home that finds the right setting of care for all patients and their families. Innovations in care coordination and pharmacy will also become essential elements in supporting this reengineered delivery system. The outcome will be a reduction of unnecessary care and hospitalizations, and better patient care overall.

We know that a shared clinical strategy with our ACO providers is the key to our future success, and that we need to increase the levels of innovation and collaboration to advance clinical best practices in key areas. In doing so, we can achieve better management of complex, chronically ill patients and improved quality of care.

Developing ways to help our providers address the challenges inherent in the current system has been an exciting process. We believe this new way of looking at the healthcare processes can provide patients the right care at the right time in the right setting, at sustainably affordable prices.

Stuart Levine, M.D., M.P.H., is vice president, chief innovation and clinical care officer at Blue Shield of California