Philadelphia-based Independence Blue Cross (IBC) says a pay-for-performance payment initiative with Abington Health, launched a year ago, is on track for success primarily because its physicians are engaged.
Doug Chaet, senior vice president of contracting and provider networks for IBC, says Abington is committed to the new model of healthcare that coordinates care to keep patients healthier.
"They really are taking this seriously from a practitioner perspective. One of the problems, historically, I think, with pay-for-performance programs in general is that a provider and a payer can reach agreement and they agree to hit a certain target, but the providers aren't always engaged and as committed to the performance as Abington has been, and that in and of itself is a big success."
Chaet is careful to call IBC's Integrated Provider Performance Incentive Plan (IPPIP), an accountable care payment model, not an accountable care organization.
"A lot of people these days refer to accountable care as any kind of program where providers are accountable for the cost and quality of care delivered, and I think that's why we have termed IPPIP an accountable care payment model because that's exactly what it does," he says.
The health insurer's IPPIP pays participating physicians and hospitals "substantial sums" above the standard reimbursement rate when they meet quality and medical cost targets. Chaet didn't give details about the incentive payment amounts, but he says the model is deployed to 85% of physicians and hospitals within its network, including Abington Health, a nonprofit system with two hospitals, two outpatient care facilities and a physician group.
Abington will find out soon whether it will receive a bonus payment from IBC. Its first full year operating with the IPPIP is this June. IBC provides the system with quarterly reports on how the system is progressing. Keith Sweigard, MD, chief of internal medicine for Abington and director for the system's medical group, Abington Health Physicians, says he's pleased with the improvements so far, but that it is mainly process driven.
"I think the outcomes will bear themselves out of a little bit longer period of time. I think that in this first year we were still working a lot on the infrastructure," says Sweigard.
One key to that infrastructure is a new component to Abington's partnership with IBC. The two announced in February it would be using Lumeris to help integrate data to give Abington's physicians a more complete view of its patient population.
"IBC has a claims database and Abington's hospital and physicians have electronic medical records," says Sweigard. "Lumeris basically pairs the claims data with clinical data and produces reports with the capability for additional drilldown."
IBC claims this three-way partnership is one of the first of its kind, and Chaet says the reporting function Lumeris will deliver sets Abington Health apart.
"Historically, the big data gap in our industry is that physicians didn't have access to the claims data or hospital EMR. This pulls it all together for them and arms them with more information than they typically ever had, and it really is painting such a broad picture," says Chaet.
Abington will start using the aggregated reports in May. Sweigard says the system has been building the infrastructure to move toward a more coordinate care approach by hiring care managers and scheduling advocates for its outpatient clinics. Sweigard also says its designing a new workflow that is team oriented and includes the physicians, medical assistants, schedulers, and care managers.
These aggregated data reports are expected to show Abington's physicians where there are opportunities for catching what Sweigard calls the "unworried sick." He says the reports will assign a risk score to patient populations who are the most vulnerable to complications or hospitalizations.
"We can get resources into those patients' homes to make sure they're getting the maximum care so that, frankly, they're getting the best outcomes and we're actually addressing the costs of care," says Swiegard.
"In our current world, which is transactional, we are always focused on the patient that is sitting in front of us, and many times they are the worried well, and we need to address the unworried sick at home that are not coming in for care, and through the reports, we'll be able to follow these people with really more impact on their health outcomes."
Once the new system is up and running this summer, IBC will measure Abington's hospital readmission rate, hospital acquired infections, as well as core measures from the Centers for Medicare and Medicaid Services (CMS).
Sweigard says Abington is aiming toward a goal of reducing readmission rates by 15% for high risk conditions.
"We're energized by the idea that we would be providing the kind of care to a patient that reliably gets them out correctly the first time and [having] programs in place to keep them comfortable in their homes," says Sweigard.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.