Florida Blue Cross, the largest commercial payer in Florida, has established an “Oncology ACO”

Presentation on theme: "Florida Blue Cross, the largest commercial payer in Florida, has established an “Oncology ACO”"— Presentation transcript:

Florida Blue Cross, the largest commercial payer in Florida, has established an “Oncology ACO” that is one of the first specialty ACOs in the U.S.

Florida Blue Cross Blue Shield

2.9 million members in 201317th largest commercial payer in the U.S.

Oncology accounted for 25% of total spend in 2012 with significant annual increasesNeeded to find a way to control costs while maintaining quality

PROBLEM

Developed accountable care contracts with two of their largest providers of oncology care for six common cancer types (breast, female reproductive, male reproductive, digestive, respiratory, lymphatic, blood)

SOLUTION

Baptist Health South Florida/Advanced Medical Specialties (AMS)

AMS has 46 oncologists in Miami that admit to Baptist Health South Florida AMS is historically a high-cost practice but recognized that a change needed to happen

Moffitt Cancer Center330 oncologists throughout Florida Historically provides more efficient care, but room for improvement Physicians salaried

The Oncology ACO uses a “cancer year” to assess total cost of care; shared savings are determined by cost savings and quality measurement

Shared savings are determined by cost savings as well as adherence to quality metrics:

Shared Savings Calculation

All fee-for-service costs for an individual patient following diagnosis

Excludes major trauma

DiagnosisOne Year

Costs compared against baseline to determine shared savings

The Cancer Year

Established baseline ACO membership in that “year”

Established baseline total cost of care for the ACO membership in that yearEstablished annual cost of care per ACO member in that year

Baseline Calculation

355 patients

$27M

$96,000

AMS example:

Physician Quality Metrics

Chemotherapy regimen compliance

QOPI

“End of life” metrics

Hospital Quality Metrics

Participation in The Society of Thoracic Surgeons National Database

Participation in a Florida, or national, surgical care quality initiative

Perform at or above the Florida state average, for all reporting hospitals, for multiple CMS measures

While both institutions saw cost savings in the first year, Moffitt excelled while the Baptist/AMS partnership had to initiate an entire cultural overhaul

Experienced

difficulty adapting to the accountable care environmentAn overall culture change needed to be had in both

institutions (historically fee-for-service and focused on chemotherapy margins to drive revenue)Different IT systems between AMS/ Baptist Health made care coordination difficultSmall improvement in cost trend in the first performance year of the program

Structural

necessities were in place to achieve success

All physicians are salaried, and there is an ingrained culture of providing efficient, quality care, making improved care management an easier task

Projected to be able to recognize 7-figure savings in the first year of the program (2013)

Baptist Health South Florida/Advanced Medical Specialties (AMS)

Moffitt Cancer CenterFlorida Blue is still trying to identify specifically where cost savings were derived, although they do know that some cost savings came from reduced chemotherapy use

Florida Blue recognizes that the easiest way to achieve savings is by reducing the quantity of services rendered, but they are hoping to drive an overall culture change where physicians understand their risk and financial responsibility while working to achieve the highest quality

care