Rise of the ACO: Emory, Blue Cross team up

Print Friendly and PDF By: Andy Miller Published: Jan 22, 2014

A partnership of health care heavyweights was created Wednesday as Emory Healthcare and Blue Cross and Blue Shield of Georgia announced a collaboration to improve quality and contain costs.

The two entities will form an “accountable care organization” that will seek to enhance the care experienced by patients in the Atlanta region.

image001-5ACOs are networks of hospitals and doctors — and sometimes insurers –- that arose as a central feature of the federal health reform law of 2010, also known as the Affordable Care Act.

Medical providers in ACOs typically are rewarded based on the quality of care they provide. Under a special Medicare program, the organizations get paid more for keeping their patients healthy and out of the hospital. Many such ACOs have been formed in Georgia.

Blue Cross, the largest insurer in the state, and Emory Healthcare, with the highest revenue of any Georgia health system, will market the ACO to employers, not Medicare patients, officials said Wednesday.

Such collaborations, which once would have been startling, are now occurring frequently in health care, driven by the need to reduce costs. Two large metro Atlanta health systems, WellStar and Piedmont, have themselves launched a joint insurance company offering Medicare Advantage and commercial insurance, as well as serving the two organizations’ employee base.

Morgan Kendrick, the Blue Cross president, emphasized Wednesday that the steady increase in health care costs is unsustainable.

“This collaborative partnership features incentives for both organizations to achieve improved health outcomes for thousands of Georgians,’’ Kendrick said.

Patient participation will be voluntary, he added.

BCBSGA_4CEmory will be accountable not just for providing the services of the Blue Cross ACO members but for the cost and quality of their care.

The ACO will seek to increase coordination in how patients are cared for, so medical services that are duplicative, potentially harmful or simply unnecessary can be eliminated.

Many patients currently fall through the cracks in the medical care system, said John Fox, president and CEO of Emory Healthcare, which has 1,830 licensed patient beds and a network of 1,800 physicians.

“This is an exciting opportunity that we strongly believe will have a profound and positive impact on the way health care is delivered throughout Georgia,’’ Fox said.

Medical care will be enhanced as physicians share information electronically with one another and with Blue Cross, officials said. Patients will be more engaged in decision-making.

“We want to go to these types of arrangements with all of our carriers,’’ Fox said. “We believe this is our future.’’

David Smith of Kearny Street Consulting told GHN on Wednesday that ACOs are still in their infancy, and it’s too early to judge their success at cutting health costs.

“It does put the providers and the [insurer] together as partners,’’ he said.

The Emory/Blue Cross ACO, Smith added, “is going to wake up the [health care] community.’’

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