Blue Cross and Blue Shield of Nebraska is proud to announce two of its partners in delivering Total Care are growing from Patient-Centered Medical Homes (PCMHs) to Accountable Care Organizations (ACOs).
BCBSNE’s Total Care recognizes providers who focus on health care rather than sick care – reimbursing them based on quality of care and patient health outcomes rather than the volume of services performed. Total Care value-based programs are intended to ensure patients see primary care providers who know their medical history, understand their preferences and effectively coordinate optimal care in collaboration with specialized practitioners.
“Being a primary care physician myself, I’ve always felt like we are the captain of the ship,” Dr. Debra Esser, BCBSNE’s chief medical officer, said. “Patients come and tell us their problems, and we direct them to where they can get the best care.”
PCMHs are clinics anchored by family or internal medicine practitioners, as well as pediatricians, that work together to coordinate care, monitor quality and ultimately lower costs. They receive help from BCBSNE to manage care for their patient populations and consistently report quality outcomes, earning bonuses when targets are met. These quality targets help practices address gaps in care, resulting in better health outcomes for patients.
ACOs are typically larger hospital systems and/or networks of clinics working together to share data and best practices across their patients’ entire continuum of care and assume more financial responsibility for patient outcomes.
Clinics like AFHC and CCH often start delivering value-based care as PCMHs, with intent to evolve into ACOs. As Total Care providers, they receive data analytics from BCBSNE on their patient populations to support care coordination.
In transitioning from PCMHs to ACOs, AFHC, which is a primary care provider in Auburn, and CCH, a Lincoln-based pediatric practice, will have access to more data and the ability to share best practices with other clinicians who are part of the ACO.
Dr. Mike Zaruba, AFHC physician, said implementing these best practices will improve the care all patients receive, regardless of whether they have BCBSNE insurance.
“The ACO may have a clinic that’s doing well on colonoscopies, and they have a clinic that’s doing well on HPV vaccinations and another doing well on diabetes care,” Zaruba explained. “You can share your best practices and thoughts, so you don’t have to re-invent the wheel. Then, you start providing that care throughout your clinic.”
BCBSNE’s partner ACOs, which represent 1,569 primary care providers across 220 clinics and serve 241,000 BCBSNE members, include:
• Bryan Health Connect ACO
• CHI Health Partners Omaha
• CHI Health Partners Greater Nebraska
• Great Plains Health Innovation Network
• The Midwest Independent Physician’s Practice Association (MIPPA)
• Nebraska Health Network (NHN)
• OneHealth Nebraska
• OneHealth Nebraska – Grand Island
• South East Rural Physicians Association (SERPA)
• Think Whole Person Healthcare
In 2018-2019, Total Care resulted in $60 million in shared savings for ACOs and employer groups with BCBSNE insurance. Additionally, BCBSNE members seeing Total Care physicians had fewer ER visits, better blood glucose control and underwent cancer screenings at higher rates than members who did not visit PCMHs or ACOs.
“I believe both OneHealth Nebraska and CCH are providing excellent quality and will continue to grow and provide more value as we get even more information and tweak our processes to continue to do a better and better job for patients,” Dr. Sian Jones-Jobst, CCH physician, said.
“Any time you can be attributed to an ACO, then you know that you’re joining a practice that has made a commitment to high-quality, low-cost care,” Esser said. “If you’re an employer group or patient, you can really rest assured that you’re getting the best care by belonging to or being attributed to an ACO.”