For insurance companies which, for years, have tried with varying success to get patients to follow advice and physicians to focus on the value of the care they provide, contracting with a clinically integrated network offers a welcome new model for patient care and satisfaction that offers transparency, information sharing and measurable goals for improvements in quality and costs.

 

Working with Florida Blue, Holy Cross Physician Partners (HCPP) in Fort Lauderdale created one of the first commercial accountable care programs in the state and recently launched Cigna’s first collaborative accountable care initiative in South Florida. Under these agreements, HCPP currently manages a patient population of more than 13,000.

 

Holy Cross Hospital provided the start-up capital and infrastructure for our physician-led organization. When beginning the planning process to select our first payer partner, we first contacted numerous insurers that had existing contracts with the hospital. Nine commercial insurers responded to a formal RFI process and we met with six in full-day interviews.

 

We found proposals varied by business models and methodologies; however it was clear that insurance companies understand that engaging physicians in the practice of population heath management to improve quality and lower costs has to be part of the product design for health plans in the future.

 

There are several elements of value-based agreements that are of interest to payers:

• Contracts require a network and infrastructure which can serve the needs of a large patient population. Recognizing the shift toward value-based contracts and with a desire to do it first, Holy Cross Hospital provided the resources and technology needed. HCPP consists of approximately 170 physicians employed by Holy Cross Medical Group and 130 independent community physicians. We are still enrolling physicians, particularly primary care physicians, which currently account for more than one quarter of HCPP providers.

 

• Provider health care information technology and payer claim data are a powerful combination to improve patient care. HCPP utilizes sophisticated information systems to identify patients in need of outreach as well as provide point-of-care decision support tools to its physicians.

 

• Consumers benefit from improved care coordination, lower out-of-pocket costs and greater emphasis on preventive care. HCPP employs two registered nurse population care managers who check to see if patients have had recommended tests and screenings. They also provide patient education and follow up with patients after treatment which may include coordinating community and social services.

 

• Providing for seamless coordination between the network and the payer is paramount to ensuring a satisfactory patient experience. HCPP population care managers collaborate with payer case managers in a variety of ways which might include using patient-specific payer data to help identify patients that require follow up or referring patients to payer clinical support programs such as diabetes and heart disease management programs and lifestyle management programs for tobacco cessation, weight management and stress management.

 

• HCPP physicians are rewarded for improving patient health and lowering medical costs. In a contract which has been in effect for more than one year, we were able to track quality metrics for: HbA1C measurement in diabetic patients; nephropathy assessment in diabetic patients; LDL-C screening in diabetic patients; breast cancer screening; cervical cancer screening; and colorectal cancer screening. Physicians who met or exceeded pre-defined quality metric thresholds will receive a shared-savings incentive bonus.

 

Having recently completed the first year of a payer contract, HCPP has been grown the number patients, exceeded the Florida peer group quality score by over two standard deviations on the composite measure and recognized a shared savings. We continue to meet with payers and we expect a significant portion of the Holy Cross Hospital’s commercial business will transition to value-based contracts over the next five years.