Sixty thousand more Rhode Islanders - Blue Cross and Blue Shield of Rhode Island commercial health insurance members - will be enrolled in health care projects designed to save money and improve care.
It's called an Accountable Care Organization, and Blue Cross has a new agreement with Integra, which manages an ACO for Care New England and South County Health. The insurer has already announced a similar agreement with Lifespan.
An Accountable Care Organization, or ACO, is supposed to work like this: primary care doctors keep you healthy and out of the hospital. If they save money, they get to share in that savings. One such ACO already underway includes physicians with Care New England and South County Health. The group is opening eight new primary and urgent care clinics to provide patients alternatives to the emergency room, which can be expensive. The clinics will link up electronic health records with the ACO and physicians.
ACO manager Integra’s chief clinical officer Dr. James Fanale describes a patient visit.
“The information about that visit will be rapidly communicated to our primary care physician, they hopefully won’t do as many tests because they have access to our medical records," said Finale, "and really make a much more efficient visit.”
This agreement covers Blue Cross members with commercial health insurance, but Integra's ACO has been up and running with some Medicare members.
It’s too soon to tell when the project will achieve savings or how much patient health will improve, but the Centers for Medicare and Medicaid will monitor progress.
Fanale says Integra has been using electronic health records and a statewide health information exchange, called CurrentCare, to help doctors pinpoint populations of patients who need help getting their illnessness under control.
“Hopefully, with our care management program, where we care for the sickest patients, work with the primary care docs, to make sure that patients receive the right care at the right time. You know, preventing over-utilization of hospitals, skilled facilities, EDs," or emergency departments, said Fanale.
Fanale says that right now, patients with chronic illness use the emergency department often because they lack access to convenient care.
This is one of several projects underway in Rhode Island to connect a patient’s health with how doctors get paid. Some are showing signs of paying off, others are still too new to offer up any data. Many are funded by money from the Affordable Care Act.