Today marks the one-year anniversary of Capital BlueCross' launch of two Accountable Care Arrangements (ACA). Preliminary results demonstrate that this innovative care delivery model is improving care coordination, lowering the medical cost trend, and improving the member's management of chronic conditions and overall satisfaction with care. This initiative builds off of the experience Capital BlueCross gained after implementing the region's first private patient-centered medical home pilot in 2010.
By focusing on a holistic approach to patient care and working with the patient to establish and manage a comprehensive plan of care, Capital BlueCross and its physician partners are helping to:
- Enhance patient access to care
- Decrease the risk of hospital readmissions and preventable complications
- Promote the use of preventive care and wellness services
- Facilitate improved communication and care coordination
Under the ACA model, Capital BlueCross partners with primary care physician practices to provide dedicated nursing resources and technology to deliver patient-centered, holistic care. By optimizing the use of technology enabled tools, such as a Population Management Tool, members with complex medical conditions or those at risk for a medical condition are identified for outreach, education, and referral for additional clinical, wellness, or community-based services. The Population Management Tool identifies members who have not received all preventive services appropriate for their age and medical condition.
As an example, a Capital BlueCross member diagnosed with type II diabetes will now receive an enhanced level of care coordination for all preventive care, ongoing treatment and specialty care, no matter which physician or specialist the member has accessed.
The member in this illustration would be assigned a Capital BlueCross care coordinator who would work closely with caregivers to ensure that patient has timely doctor appointments, on-site blood glucose tests, a customized nutrition and exercise program, a support group, and a comprehensive understanding of the medical bills and insurance benefits
Both the physician practices delivering the care and their Capital BlueCross patients are embracing the new ACA model. For example, in a recent survey of the participating practices 100 percent of the respondents reported that they were satisfied or very satisfied with the care coordination program, and with the knowledge level of care coordinators regarding available community\network resources. One respondent commented that their care coordinator was "knowledgeable and very willing to help when needed."
Additionally, patient participation rates for care coordination are very high, with 75 percent of patients participating in recommended care management and self-help programs. This participation rate is double the industry standard.
Last May, Capital BlueCross launched ACA programs with Lemoyne Pa.-based Heritage Medical Group and Physicians' Alliance, Ltd. (PAL) in Lancaster, Pa.
"It is no surprise that Capital BlueCross' Accountable Care Arrangement was successful in its first year," said Dr. Michael Warren, Physicians' Alliance Ltd. "We instituted the program in our practice and the feedback from patients has been extremely positive. Capital BlueCross members are noticing better coordination of their medical care, and we are witnessing a higher level of satisfaction among these patients. This has been a true partnership in the delivery of care -- one that is working as advertised."
"Early indications from patients are promising that the ACA concept is working," said Dr. Christopher Rumpf, Capital BlueCross Chief Medical Officer. "It is important that through this model, the patients feel as though they are receiving a complete spectrum of care. At the same time, the physician practice should feel it is providing a more comprehensive, accountable approach to the delivery of medical services. From what we are seeing and hearing, this is all happening."
Capital BlueCross has a long history of bringing innovative programs and resources, like ACAs, to its members and the community to help reduce cost, increase quality and improve satisfaction. The company is in discussions with other area physician groups interested in partnering with Capital BlueCross on an ACA.
Capital BlueCross is the leading health insurer in its region, providing health insurance coverage to residents in central Pennsylvania and the Lehigh Valley.
Capital BlueCross is committed to making health insurance simple for its customers and members through all the stages of life by offering nationally acclaimed customer service and a full range of innovative benefit programs for groups and individuals at competitive prices.
By establishing a culture of caring, Capital BlueCross constantly strives to do more in order to deliver more for the men, women and children who depend on the company for their health insurance needs. Capital BlueCross has been providing medical value to the people and communities of central Pennsylvania and the Lehigh Valley for more than 70 years and employs over 1,800 people in the region.
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