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Core 4 Stories: Blue Shield of California and AppleCare Create Successful Advanced Facility Care Program

Blue Shield of California's advanced clinical model, called the Core 4, focuses on the critical components of an integrated and optimized delivery system.
(L-R) Patti Oliver, Senior Director, ACO Clinical Programs at Blue Shield of California and George Christides, MD, Chief Medical Officer, AppleCare Medical Group
(L-R) Patti Oliver, Senior Director, ACO Clinical Programs at Blue Shield of California and George Christides, MD, Chief Medical Officer, AppleCare Medical Group

BY PATTI OLIVER AND GEORGE CHRISTIDES - Advanced facility care features initiatives to ensure members receive optimal care delivery to minimize time spent in inpatient settings. Advanced facility care is delivered inpatient settings, such as hospitals and skilled nursing facilities. Initiatives to drive advanced facility care include:

  • Developing a robust hospitalist program
  • Assuring that high-quality skilled nursing facilities (SNFs) are in-network, available to admit members, and working closely with hospitalists to manage care
  • Strengthening relationships with skilled nursing facility care providers to address member needs
  • Coordinating care through thoughtful and effective care transitions when members are moving from the inpatient to outpatient setting

Through these efforts, we are providing members with the right care at the right time, in the right place. Specifically, we are:

  • Reducing the average length of stay and bed days in hospitals
  • Reducing the number of emergency department (ED) visits
  • Reducing the number of readmissions
  • Improving quality and patient satisfaction

Blue Shield’s accountable care organization (ACO) collaboration with AppleCare Medical Group, part of OptumCare, has created a results-oriented hospitalist program and a compelling example of why this work is so important. With Blue Shield’s collaboration and support, AppleCare introduced a new evolution in its care model featuring a well-established, well-staffed hospitalist program under the leadership of Dr. George Christides, Chief Medical Officer. In this robust program, the patient-to-hospitalist ratio does not exceed 12:1.

In addition, an emergency department diversion program ensures members receive the most appropriate, targeted care when they need it. Care management is offered onsite and follows a regional outpatient model. The extended-hours urgent care center across the street from the hospital even waives copayments. This model also features a true multi-disciplinary, high-risk clinic and offers home and palliative care.

To achieve their shared goals, AppleCare and Blue Shield of California took a holistic and collaborative approach to implementing and operationalizing this program. AppleCare’s highly invested stakeholders, and Blue Shield’s clinical support and in-person investment were also instrumental in the success of this program.

Early inpatient results have been encouraging, and show significant improvements in key metrics:

  • Inpatient days per 1,000 are down 18.3%
  • Average length of stay is down 20%
  • Emergency department visits per 1,000 are down from 5.4% in 2015 to 4.3% today
  • 65 patients per month in non-preferred EDs and inpatient facilities were transferred to preferred facilities
  • Annually, 12% of patients in non-preferred EDs were able to be redirected home with appropriate clinical support

These results tell us the future is bright for this advanced facility care model. In the coming months, we’ll share more ACO partner success stories around the remaining components of the Core 4 clinical model: home care, high-risk clinics and care management and coordination.