How two accountable care organizations and Boeing are testing value-based care

Boeing building photo from wall-street.com.

A new partnership between two accountable care organizations and Seattle’s largest employer hopes to become a model for value-based care.

The Providence-Swedish Health Alliance and UW Medicine have entered into separate and direct contracts with Boeing, among the first ACOs in the country to create a tailor-made healthcare plan with a private employer.

Administrator Blue Cross of Illinois continues to price and pay the claims, but it’s up to the providers to set the goals for the employees’ medical costs, according to Boeing spokesman Joseph Tedino. The healthcare providers either foot the bill or reap the savings if the cost goes respectively higher or lower, Tedino said.

[Also: Complete liste of Medicare ACOs]

“Our promise to Boeing is to deliver value. We’re on the hook for the promise,” said Joe Gifford, chief executive for Providence-Swedish Health Alliance.

Open enrollment began Jan. 1 for the estimated 27,000 eligible employees in the Puget Sound-area, along with about 3,000 retirees. Employees had the option of the new Preferred Partnership plan, a PPO, or a high-deductible plan.

While Boeing does not release enrollment figures, sign-up for the Preferred Partnership exceeded enrollment targets, according to Tedino.

“This new plan was popular with our employees in Puget Sound,” he said.

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Enrollment was about evenly divided between Providence and UW Medicine, he said.

An estimated 9,000 employees selected UW Medicine, according to Johnese Spisso, chief health systems officer and vice president for Medical Affairs.

“It exceeded expectations, it surprised everybody,” Gifford said.

Beyond lower paycheck deductions, employees were attracted to a plan that had, in many cases, no copays for primary care visits and full coverage for generic drug prescriptions.

Services include same-day appointments, concierge privileges by phone or e-mail and mobile access for scheduling primary care appointments and reviewing test results.

Virtual care is reimbursed, something not done under the traditional method of payment.

Providers coordinate appointments and treatment across their network of doctors, clinics and hospitals. Patient data is shared with providers, allowing doctors to have a record of whether a patient followed through with a prescribed plan.

Benchmarks are tied to costs, including hospital readmissions and the management of chronic conditions such as diabetes and heart disease.

“We’re meeting and exceeding service standards. We just had a great experience working collaboratively with Boeing for the triple aim,” said Spisso.

Meanwhile, Gifford said he predicts market expansion in the five states in which Providence provides care.

“Southern California has got employers we’ve been talking to actively,” he said.

While it helped that Boeing is such a large company, Gifford said he is working on ways to offer ACO benefits to smaller employers in partnership with insurers.

Providence-Swedish Health Alliance also partners with the Centers for Medicare and Medicaid Services and was approved as a Medicare ACO in 2013.

There were more than 600 ACOs nationwide at the start of the year, and they are being touted as a key strategy for curbing U.S. health-care costs as doctors and hospitals are reimbursed for value of care, rather than fee-for-service.

“The track is to take care of communities directly,” Gifford said. “It does require us to spend money on innovative care. The framework we’re putting in place, this is a model for the future of healthcare. By our ability to coordinate care better for a population, we feel we can reduce the cost of care through better care coordination. Everyone is interested across the U.S. Our phone is ringing from employers.”

Twitter: @SusanMorseHFN