Dallas-based accountable care organization (ACO) Baylor Scott & White Quality Alliance (BSWQA) has been steadily adding health plans to its ranks. The ACO said Aug. 31 that it will be joining forces with Cigna Corp., the third health plan it has added since the ACO launched in 2013.
BSWQA is affiliated with Baylor Scott & White Health (BSWH), the largest not-for-profit health system in Texas, and is comprised of more than 5,000 primary and specialty care providers, 48 hospitals, post-acute care facilities and other entities that work together to be jointly accountable in a risk-sharing venture to improve the quality of patient populations while reducing health care costs. BSWQA began partnering with Aetna, Inc. in 2014 and UnitedHealth Group in 2015.
Blake Allison, chief operating officer at BSQWA, tells AIS Health that the ideal strategy is for the ACO to partner with all of the health plans that cover the ACO physicians’ patients in order to better improve quality and care outcomes. Health plans that work with BSWQA contribute their entire set of claims data for BSWQA enrollees to the ACO, and that data is used to educate and inform physicians about the care their patients are receiving, even when they leave the BSWH system. The more complete the data, the better the understanding, Allison says. The payers that work with BSQWA are also part of the governance process behind the ACO, he says.
According to Allison, it took about a year to work out the arrangement with Cigna, which will add more than 40,000 Cigna lives to the ACO.
The ACO uses claims data to attribute patients to the primary care physician they most often visit, Allison says. Physicians are then held accountable for improving the outcomes of patients attributed to them, and they are aided by the vast stores of data made available by the health plans in the ACO. BSQWA receives data on a monthly basis from the plans, then scrubs and stores the data and pushes it to a dashboard for physicians to use.
On a regular basis, BSQWA and the health plans analyze the data and provide physicians with insight that can help them improve care and save money. The health plans create their own reports, which are compared with reports the ACO also runs on the data to see how to improve the population’s health status. Each payer and the ACO define quality targets and share in the savings they work to achieve, according to Allison.
So far, payers have contributed some 9 billion pieces of data to the ACO. “It’s a heavy lift,” Allison says. The reason all the data are important is they provide a clearer picture to a physician of where the patient is going and for what reasons. Data are not siloed according to health plans, because “physicians don’t see things that way,” Allison says. Physicians see things in terms of human lives, not by which insurance carrier a patient has.
BSWQA points to its recent results in managing the health of employees within a large employer group that the ACO declines to identify. Over a 5-year period, the ACO reported 13% fewer hospital admissions, 19% higher use of in-network services, a 0% medical cost trend and $57 million in savings.
As part of BSWQA’s contracts with health plans, the carriers agree to encourage employers to participate in the ACO. “Cigna is one of the best at really getting all of their employers to buy in,” Allison says. “It’s good for Cigna, good for us and makes the employees happy. We are truly attempting to align the consumer, payer and providers — and that’s what makes us unique.”
Cigna has worked with other units of Baylor Scott & White on collaborative care since 2012, Cigna spokesperson Mark Slitt tells AIS Health. This newest agreement expands on that.
“This expanded arrangement brings the ACO affiliated with Baylor, Scott & White Health into our Cigna Collaborative Care program, and extends the benefits of the program to even more Cigna customers in the Dallas/Fort Worth Metroplex,” Slitt says. “It’s part of our continued focus on creating value-based arrangements with health care providers, not only in North Texas, but all over the country, to meet our goal to have 50% of our medical reimbursements in alternative payment models and 90% of them in value-based arrangements by the end of 2018.”
Slitt says Cigna plans to build more arrangements like the one with BSWQA, as well as collaborative arrangements for providers of specialty care, such as oncology, maternity care, hip and knee surgery, colonoscopy and other procedures. “These arrangements come in a variety of forms that reward physicians for the quality and the value of the care they provide, including episodes-of-care and pay-for-performance models,” he says.