Excellus BlueCross BlueShield
This is Health Reform – ACQA Partnerships Benefit Patients, Providers, and Payers
Vice President, Health System Performance
Over the past decade, healthcare in the US has been characterized by tremendous variations in quality and low provider margins, even as escalating costs have dominated the healthcare dialogue.
A survey of employer-sponsored health benefits conducted by The Henry J. Kaiser Family Foundation and the Health Research & Educational Trust found that the cumulative increase in insurance premiums was close to four times the cumulative increase in wages between 1999 and 2015.
Faced with annual increases in healthcare premiums, employers were looking to control costs. Excellus BlueCross BlueShield knew something had to change. The size of Excellus BlueCross BlueShield’s membership and strong provider relationships gave them the opportunity to introduce an innovative payment program with select providers in 2012.
The goals of the Accountable Cost and Quality Arrangement (ACQA) are to improve patient satisfaction and outcomes while reducing healthcare costs. Unlike the prevailing payment system, which rewards providers for volume, the ACQA payment arrangement provides an incentive for providers to focus on value by improving the quality of healthcare, lowering costs, and enhancing patient experience — much like the “triple aim” of the Accountable Care Organizations model. This triple aim is achieved through:
- More physician – patient engagement to coordinate care and improve health outcomes
- Emphasis on preventive care, patient safety, and chronic illness management
- Improved efficiencies through the reduction of unnecessary, duplicate healthcare costs
- Shared savings incentives for providers who demonstrate efficiency and meet quality metrics
For its part, Excellus BlueCross BlueShield medical directors, clinical performance improvement consultants and pharmacists work with each ACQA partner to identify areas where costs can be cut.
By carefully monitoring quality metrics, Excellus BlueCross BlueShield helps providers understand cost drivers, quality performance, and the population’s health needs. Then Excellus BlueCross BlueShield helps providers set goals for cost trends and quality and align payment with patient outcomes.
The ACQA is part of an integrated strategy that has produced a 2.5 percent reduction in Excellus BlueCross BlueShield’s cost trends over the last three years, while improving healthcare quality. In 2014, participating ACQA partners:
- Improved overall quality by 20 percent
- Achieved better clinical outcomes in all measures by an overall average of 15 percent
- Notably improved care of patients who have been diagnosed with diabetes (29 percent higher rate of patients who had a retinal eye exam and 13 percent higher rate of patients who had screening for kidney damage)
Other benefits have included lower healthcare spending, financial security for healthcare provider partners, and improved health status of Excellus BlueCross BlueShield members and the communities in which they live.
Collaboration between providers and the health plan is the key to improving patient care. When everyone shares the same vision and focuses on making communities as healthy as they can be, everyone benefits.
About the Author
Tony Vitagliano is vice president of health system performance for Excellus BlueCross BlueShield. Responsible for provider contracting, provider communications, provider relations and performance improvement, he is accountable for approximately $4 billion in provider payments in support of all lines of business. Tony has developed innovative, value-based provider arrangements and unique insurance programs, and is responsible for the management of the healthcare delivery system for the plan’s 1.6 million members. After earning a bachelor's in Engineering from Princeton University, Tony received a master’s degree in Business Administration from the University of Rochester’s Simon School of Business.
About Excellus BlueCross BlueShield
Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association, is part of a family of companies that finances and delivers vital healthcare services to about 1.6 million people across 31 counties in upstate New York. Excellus BlueCross BlueShield provides access to high-quality, affordable health coverage, including valuable health-related resources that its members use every day, such as cost-saving prescription drug discounts and wellness tracking tools. To learn more, visit ExcellusBCBS.com.