Accountable Care: The Purchasers Perspective Webinar
March 23, 2016
During the webinar, David Lansky, LAN Guiding Committee member and CEO at the Pacific Business Group on Health (PBGH), discussed the elements of ACO design and purchaser perspectives on the current ACO market. Boeing’s Jeff White and PBGH’s Emma Hoo spoke candidly about the how Boeing and the City & County of San Francisco worked with PBGH to develop ACOs for their employees. Following are edited transcripts of the live questions.
Emma Hoo - Pacific Business Group on Health
The ACO created greater emphasis to work more closely across the provider system. It is important to know that in both San Francisco ACOs, the practices involved were still fairly small, mid-sized practices grouped together under independent practice association arrangements, so there were not traditional multi-specialty groups. So there was a lot of opportunity to create better information flow between the hospital systems with primary care physicians, and so forth. Even though the APM of capitation was in place for professional services, the hospital contracting was managed separately, and there was no integrated shared savings across the two. In creating an upside incentive for shared savings, this creates better alignment across two sides to the equation.
Not so much, because the BCBS population has spiraled over time; their patient population was at much higher risk than the rest of their population so there has been opportunity for focus on chronic care management and for reverse migration to level out risk mix across the carrier options.
Jeff White - The Boeing Company
At Boeing, we wanted to be simple in terms of the number of contracts we have. Our strategy was to have one contract with one big integrated delivery system, and that integrated delivery system can go and gather partners or subcontractors to fill out the contracted system. When you are taking risk, you need to ensure the other party can have a balance sheet of those risks. That was our method of starting off.
Yes, at Boeing, we have no problem sharing those. That’s a simple win for all of us if we had one set of quality metrics we all agree upon, and we believe that is a major part of our participation in the LAN. My hope is that we coalesce around a single set of metrics.
Yes, as with most insurance plans, healthier people, in general, selected the ACO plan which is why it’s complicated to make statement about quality without controlling for that variable and risk adjusting to some extent.
Yes, the carriers play a major role in this model, particularly with claim adjudication and data flow. They have really stepped up to their role with providing better data systems to manage patients better. They understand and have been very supportive of this model. If you look at what we, at Boeing, bring to the table versus an insurance carrier, we bring a stable work force of much known risk, so I think we can get better deals when negotiating contracts. I also want to point out to employers that systems enjoy the branding of partnerships to deliver better care, such as partnerships between hospitals and employers. It is good to know what this brand can be worth.
We communicated to employees that we had a website six months ahead of time and that we had a robust provider search that was pretty simple in terms of describing the financial incentives that come with using in-network ACO providers. The providers received welcome kits after they enrolled.
The systems gently reach out to employers in the event a patient did not select a primary care provider to ask if they would like to be assigned to a medical home. Our feeling is that employees trust their providers more than they trust the company or insurance companies, or any third party advocate. We encourage the development of the relationship between the employees and their primary care providers.
David Lansky, PhD
Mr. Lansky serves as a member of the Health Care Payment Learning & Action Network’s Guiding Committee. He serves as President and Chief Executive Officer of the Pacific Business Group on Health and directs its efforts to improve the affordability and availability of high quality health care.
Jeff White, MBA, MS
Mr. White serves as a member of the Health Care Payment Learning & Action Network’s Population-Based Payment Work Group. He is Director of Health Care Strategy and Policy at The Boeing Company where he leads a team responsible for health care benefits strategy, contract negotiations, and plan policy, which accounts for $2.6 billion in annual spending. Mr. White and his team take an active role in partnering with the provider community, associations, and other industry stakeholders to explore innovative improvements to health care delivery systems ranging from deep clinical programs, like Medical Homes, to broader network strategies such as Centers of Excellence and Accountable Care Organizations (ACOs).
Ms. Hoo is a member of the Health Care Payment Learning & Action Network. She is a Director at the Pacific Business Group on Health.