Inside an ACO-Like Partnership

Jacqueline Fellows, for HealthLeaders Media , March 4, 2013

The health insurer's IPPIP pays participating physicians and hospitals "substantial sums" above the standard reimbursement rate when they meet quality and medical cost targets. Chaet didn't give details about the incentive payment amounts, but he says the model is deployed to 85% of physicians and hospitals within its network, including Abington Health, a nonprofit system with two hospitals, two outpatient care facilities and a physician group.

Abington will find out soon whether it will receive a bonus payment from IBC. Its first full year operating with the IPPIP is this June. IBC provides the system with quarterly reports on how the system is progressing. Keith Sweigard, MD, chief of internal medicine for Abington and director for the system's medical group, Abington Health Physicians, says he's pleased with the improvements so far, but that it is mainly process driven.

"I think the outcomes will bear themselves out of a little bit longer period of time. I think that in this first year we were still working a lot on the infrastructure," says Sweigard.

One key to that infrastructure is a new component to Abington's partnership with IBC. The two announced in February it would be using Lumeris to help integrate data to give Abington's physicians a more complete view of its patient population.

"IBC has a claims database and Abington's hospital and physicians have electronic medical records," says Sweigard. "Lumeris basically pairs the claims data with clinical data and produces reports with the capability for additional drilldown."

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