Success key No. 4: Accountable care organizations
At least 16% of total Florida Blue's medical expenses over a year's period were linked to cancer care. Those figures prompted the insurer to team up with Baptist Health South Florida and Advanced Medical Specialties, the medical group, to initiate an oncology ACO.
The collaboration focuses on six of the most common forms of cancer: leukemia, lymphoma, breast cancer, lung cancer, colorectal cancer, and male and female genitourinary cancers. All told, they represent 80% of all cancer types in Florida. An early examination of data "shows trends in a good direction" for cost savings, Lawson says.
"This is an ACO-like shared savings arrangement," Lawson says. "It is ACO-like from the standpoint that participating providers are coordinating care for this defined oncology population with the goals of increasing quality and efficiency while reducing cost and unnecessary services," he says.
Baptist Health will assume the risk for cost of care. "We found cancer care has complexities unlike some of the other service lines," he says. All parties agreed that collaboration was necessary to cut costs, says Lawson. To carry out effective coordination, it was also important that senior leadership in each of the three organizations was engaged in setting strategy, he adds. Negotiations were sensitive because the parties felt they were breaking new ground, including the need to divulge financial information.
"To attempt to make an impact on the cost of care, it is important to understand the complete picture—services rendered, patterns of care, ED frequency, etc.," he says. "The only way to build the complete picture is for all three parties to share clinical and financial information. This requires a new level of disclosure and transparency among parties that are typically on opposing or competing sides and must now learn to work together toward shared goals.
"Florida Blue is very much a partner in setting and achieving these goals. Part of the initial phase of this program was the formation of several subgroups and task forces. It is the only way to ensure that, with so many moving parts, nothing falls through the cracks," Lawson says.
"The clinical subgroup is tasked with identifying opportunities along the continuum of care," Lawson adds. "Patients are often bombarded by duplication efforts, information-related material, advanced directive documentation, and reminders. By simply coordinating some of these efforts, the patient's experience is positively impacted and resources from duplicative areas can be directed to more beneficial use."
Jonathan Gavras, MD, chief medical officer and senior vice president at Florida Blue, also says that all parties were present together throughout the process. "Cancer costs have been an issue throughout the U.S. and particularly in Florida for a long time," Gavras says. "For three months, we ground through the analysis of data. We shared information with each other that we never would have shared before."
Team meetings among the groups are held to "review data and maintain adherence to time frames and initiatives," Lawson adds. The task force includes three members from all parties in the transaction and shares all the "available data concerning the cancer patients treated at Baptist Health."
Baptist Health's and Advanced Medical Specialties' information technology teams are also working diligently on the development of appropriate and compliant processes to achieve more real-time sharing of target population information. This would be a breakthrough for emergency visits to Baptist Health facilities, so cancer patients can avoid duplication of care or unnecessary diagnostic testing, according to Lawson.
"You have to have a lot of trust developed," Gavras adds.
Indeed, trust-building counts in every aspect of payment-bundling for cancer service lines.
This article appears in the January/February 2013 issue of HealthLeaders magazine.