The Texas-sized ACO itself is a work in progress, so specific details are scarce. Both partners are experienced players in terms of adopting innovative approaches to reduce healthcare costs. Memorial Hermann already has in place an ACO relationship with Aetna and a patient-centered medical home with Humana. It also participates in the Medicare shared-savings program. All totaled the physician network has about 300,000 covered lives under these different arrangements.
Meanwhile BCBSTX has an accountable care organization with Texas Health Resources and four active PCMHs.
Still, each deal is different. So when payers and providers enter into these agreements they have to take a hard look at their roles, notes Chris Lloyd, MD, CEO of Memorial Hermann Physician Network. "How will we do care management or outreach to patients? How will we combine our strengths?"
BCBSTX and Memorial Hermann have already started the exchange of data and information. Work sessions are also being held around care management principles and patient outreach, among other topics.
Each partner brings significant strengths to the ACO with data a strong point for both. Lloyd says BCBSTX will provide claims data across the spectrum of care—inpatient, outpatient, post-acute, surgical, and primary care—that will "provide us with a lot of transparency in terms of how we are doing" in terms of outcomes and cost savings.
He says BCBSTX also has sophisticated total cost of care accounting processes that Memorial Hermann can cross check with its own data to make sure the insurer and health system are on the same page in terms of how patients should be managed.