Blue Shield of California, St. Joseph Health to launch ACO
Blue Shield of California and St. Joseph Health System announced an accountable care initiative, set to launch Jan. 1, 2012, which is designed to serve approximately 30,000 Blue Shield HMO members in Orange County, Calif., who are patients of SJHS.
SJHS's regional delivery system in the county, includes St. Joseph Hospital in Orange, St. Jude Medical Center in Fullerton, Mission Hospital in Mission Viejo and Laguna Beach, the St. Joseph Home Health Ministry, three affiliated physician networks and three medical groups, all of which will participate in the project.
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"St. Joseph Health System has a well-deserved regional and national reputation for clinical excellence and innovation. We look forward to working together to deliver high-quality coordinated care to Blue Shield members in Orange County," said Juan Davila, senior vice president of network management for Blue Shield of California in an announcement of the collaboration. "This marks the latest milestone in our ongoing effort to transform how we provide and pay for care to make health coverage more affordable to all Californians."
Blue Shield of California currently has a number of different accountable care initiatives either running or in the final stages of design in diverse regions in the state including San Francisco, the Central Valley, Orange County and Sacramento.
The Sacramento pilot, launched at the beginning of 2010 to serve 40,000 members of the California Public Employees' Retirement System (CalPERS), has already shown encouraging results, including:
- 15 percent reduction in inpatient readmissions
- 15 percent decrease in inpatient days
- 50 percent decrease in inpatient stays of 20 or more days
- A half-day reduction in average patient length of stay
- $15.5 million saved
To achieve these improvements, health systems participating in the Sacramento pilot with Blue Shield of California have employed a number of strategies aimed at reducing costs such as coordinating operational infrastructure and clinical processes, personalize care and disease management, and reduced pharmacy costs through directed member outreach, drug purchasing and contracting strategies, among others.
Premiums for CalPERS members participating in the accountable care pilot are also 5 to 10 percent lower than members not involved, according to Blue Shield of California.
The non-profit insurer hopes to bring the same care improvements and savings to its HMO members in Orange County via its collaboration with SJHS.
To achieve this goal, the two companies will work together to share clinical and case management information and to coordinate comprehensive healthcare services. The organizations' incentives will be aligned to improve healthcare quality and patient service while reducing costs.
"As a faith based organization, we understand the importance of providing perfect care that optimizes clinical quality, patient safety and patient experience, which is why we are collaborating with Blue Shield to deliver medical cost relief to the communities that we serve," said C.R. Burke, president and CEO of St. Joseph Heritage Healthcare in a press release. "We're excited about the potential for this collaboration to advance our mission to deliver care that is safe, timely, evidence-based and efficient, while enhancing the patient experience."
This initiative will continue for a minimum of 12 months with the intent of extending the collaboration to have a material, sustainable impact on healthcare costs for members and employers over time. Preliminary work is underway across the organizations and will accelerate in the coming months.
