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Transforming Healthcare through Collaboration

BY KRISTEN MIRANDA – Blue Shield is now in our sixth year of collaborating with hospitals and medical groups throughout California to create Accountable Care Organizations (ACOs). Each party agrees to be jointly accountable for the quality, cost and access to care for a defined population of patients. ACOs are central to Blue Shield’s strategy to transform the healthcare system.

Our first ACO began in 2010 with Dignity Health and Hill Physicians Group in Sacramento. Today, we have grown to 36 ACOs serving 340,000 members, and our program is a nationally recognized model.  Between 2010 and 2015, our ACOs achieved $325 million in healthcare cost savings, and the annual increase in the cost of healthcare trend has been kept at 3.5 percent, versus 7 percent on average for the industry as a whole.

Our hands-on model is reflected in the fact that our employees – such as a project manager or a financial analyst – are often embedded within many provider organization. This level of support is unprecedented in the industry. We also work closely with our ACO providers to develop our drug formularies and medication management programs.

In addition to the above, Blue Shield convenes our ACO providers to share experiences and best practices, enabling us to learn from each other and improve.  In some cases, we make investments to strengthen the capacity of our providers. For example, we have helped physician groups build programs where dedicated doctors focus solely on hospitalized patients – a model that has the potential to reduce costs and improve care.

You can learn more about our groundbreaking efforts with ACOs in our Mission Report or by reading the recent blog on our collaboration with AppleCare Medical Group. You can also watch the following video to hear directly from our team at Blue Shield on how our ACO model is transforming healthcare.

Kristen Miranda is senior vice president of strategic partnerships and innovation at Blue Shield of California


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