The collaboration is the first specialty ACO for the large insurer, which also hopes to develop a cardiology ACO and expand its specialty ACO model statewide to promote integration of healthcare. Oncology was selected for the kick-off because is "a major specialty cost driver in the state," explains Jon Gavras, MD, chief medical officer and senior vice president-delivery system for Florida Blue.
ACOs are attractive to oncologists, who are seeing their revenue streams disrupted as payers, especially Medicare, reduce reimbursements for cancer drugs. The coordinated care approach provides an opportunity to reduce the cost of cancer care by sharing in efficiencies in the treatment process.
The Florida Blue ACO model will focus on patients who need interventional services or modalities of treatment, which tend to be intensive, expensive and involve substantial hospital costs.
Gavras says a disease such as diabetes will not be pulled into the ACO model because in the early stages of the disease treatment it is physician-, not hospital-based. He says good primary care that is managing the risk factors around diabetes, including closely monitoring blood sugars, leads to better outcomes. Gavras explains that the disease is already being aggressively managed through Florida Blue's patient-centered medical homes.
The oncology ACO with Baptist Health and AMS began on May 1 and Gavras says there is no distinct time period for the collaboration. "We're looking for an evolution of the program to enlarge in size and expand to other specialties."