Providers and Payer in California Collaborate on Coordinated Care Model

Blue Shield of California, Greater Newport Physicians, IPA and Hoag Memorial Hospital Presbyterian announced a three-year accountable care initiative designed to provide integrated, cost-efficient health care to approximately 11,000 Blue Shield HMO members in California’s Orange County.

The partnership is expected to result in little to no increase in healthcare costs for the members in the first year of the collaboration, and low single digit increases in the two subsequent years.

To achieve this goal, the organizations will identify and implement long-term strategies aimed at improving quality and efficiency to ensure that health care stays affordable for Blue Shield members. The healthcare entities will work together to share clinical and case management information and to coordinate comprehensive healthcare services. The organizations’ incentives will be aligned to improve healthcare quality and patient service while reducing costs.

This initiative launches July 1, and will continue for a minimum of 36 months. It is the parties’ collective intent to extend the collaboration even longer in order to have a material, sustainable impact on healthcare costs for members and employers over time. The goal is to build a care delivery model that improves quality through better coordination of care while taking costs out of the healthcare delivery system. Preliminary work is already underway across the three organizations, and will accelerate in the coming months.

“Greater Newport Physicians has always been a leader in adapting to the dynamic healthcare environment to better serve the needs of our patient population,” said Cassidy Tsay, MD, MBA, medical director of Greater Newport Physicians. “We coordinate the care of our patients as they navigate throughout the entire health care system, because we know that patient care includes prevention, chronic care management, acute episodes of care and post-hospitalization recovery. We look forward to sharing this philosophy with our partners.”