BCBSA: Jody Voss Gives National Perspective on ACOs
Jody Voss is the Vice President of Strategic Business Services at the Blue Cross and Blue Shield Association (BCBSA). She worked with Blue Cross and Blue Shield of Illinois for 17 years before joining the Association where she has carried multiple roles. Her entire career has been with Blue Cross and Blue Shield, and over the years, she has seen many changes, innovations and adoptions of new approaches to healthcare delivery. From the get go of our interview Voss emphasized the significant changes currently happening in health care with the Affordable Care Act and clearly states, “It’s an exciting time to be in health care.”
In the interview, Voss gives us a national perspective of how BCBSA supports overall efficiencies of local Blue Cross and Blue Shield companies and how Accountable Care Organizations (ACOs) are playing an important role in present and future planning.
Anna Belle Abraham: How and why is the Blue Cross and Blue Shield Association making big moves to support Blue Cross and Blue Shield companies’ development and implementation of Accountable Care Organizations?
Jody Voss: Over the years – even before the Accountable Care Act – we started to see improvements that result from evidence-based medicine and outcomes measurement. Blue Cross and Blue Shield companies started talking with providers about how to shift from a fee-for-service system to other payment models that align incentives with outcomes. The strong provider relationships that our companies possess at a local level are critical in ensuring that these new payment models work for our members.
ABA: How many ACOs do the Blues® currently have nationwide and how many ACOs are the Blues projected to have?
JV: Today the Blues collectively have over 125 Accountable Care Organizations in 19 states. So, there’s been a lot of innovation going on at a local level. You have states like Minnesota, where Blue Cross and Blue Shield of Minnesota has partnered with 10 of the largest integrated health systems with their aligned incentive contracts to improve the way care is delivered throughout the state. There are also other states that are just now starting to get into the market. Over the next few years, we see the number of our ACOs almost doubling in over 40 states.
ABA: Are these ACOs mostly hospital-based or is BCBSA also working with physician-based ACOs?
JV: Right now there is a good mix of hospital-based and physician-based ACOs among the Blues. The Blues also have a very strong Patient Centered Medical Home presence which can serve as a solid foundation for new accountable care models. The Blues are experimenting with multiple types of payment innovations to see what brings the most value to our customers.
As more results come in, we are seeing the identification and integration of best practices for existing ACOs and ACOs in development.
ABA: How is the return on investment for ACOs from a business perspective?
JV: What’s great about an ACO is that it truly is a partnership. It’s the provider and the Blue Cross and Blue Shield company sitting down together to determine what assets there are to leverage and where the core competencies are. In addition, from an IT perspective, The Blues have always been very effective in analytics, so it certainly is taking existing capabilities and leveraging them in partnership with providers.
There is some investment, but it’s more focused on pulling together disparate data, for example prescription medication, fill rate, emergency room visits, you name it. The objective is to pull that data together, so there is a full picture of a patient. It really is more about investment in data management, then once you have the data, looking at the effectiveness of the analytics.
ABA: Has IT compatibility been a major challenge?
JV: IT compatibility is something that Blue Cross and Blue Shield companies and providers work through as part of these partnerships. It’s one where everyone is going in with their eyes open. Plans and providers sit down and identify information needs and where the areas of focus and opportunities for improvement exist. For example, if gaps in care appear, they will work to find an effective way to better manage that individual’s care. It’s about understanding essential data, where the source of the data is and then how that information is going to be shared. It really is a new relationship of transparency and data sharing. It’s about infusing this clinical information with claim information and leveraging those insights to provide higher quality care to Blue members.
The Blues have invested in IT platforms that help manage risk and help identify at risk patients. One example we wanted to highlight was Blue Shield of California. They’re integrating clinical decision support and comprehensive patient data into their ACOs. They’re looking to leverage high-speed networks and super computers to create this continuous learning center specifically designed for ACO implementation. Blue Shield of California is looking to grow their ACO partnerships to 20 by 2015.
ABA: What is your average member participation in an ACO?
JV: It varies by region. The Blues are in many different markets. Let’s look at Illinois, you’ve got Chicago, which is a metropolitan area, but then Blue Cross and Blue Shield of Illinois also services rural areas as well. From a contractual perspective, our Plans will sit down with provider partners and identify how many employees are in fact parcel of this. For example, Blue Cross and Blue Shield of Illinois has 340K members in their Illinois Advocate ACO. So, they can be quite substantial.
ABA: Is ACO information necessary for someone who wants to be a Blue Cross and Blue Shield customer?
JV: I really appreciate this question and I wish it were black and white. Basically, Accountable Care Organizations are developed for both HMO and PPO business. Members actually select their primary care physician with an HMO type product. When you start getting into the PPO world that varies, and again that is one of those discussion points that a Blue Cross and Blue Shield company has with a provider on how they want to handle it. Plans will work with providers to decide the best way to attribute individuals to ACOs. Often times it’s based on their prior utilization, if they’ve gone to that particular medical group or doctor several times over the last 18 months to two years, so they’ll attribute that individual to that doctor.
We have some ACOs where the Plan works with providers to notify patients that they have been attributed. Regardless, all members – whether notified or not – will experience a more high-touch approach to their care which includes targeted outreach and notification of programs that would benefit them such as disease management. So, member engagement is based on the local market, and what the Plan and the provider feel best will meet and reach the expectations of the patients and the members.
ABA: With all the changes and modifications you’ve experienced in your career with BCBS, where do you see ACOs heading?
JV: We see the healthcare system shifting away from fee-for-service towards a value-based reimbursement model. This is the start of it, and we will continue to grow and learn from it. It’s just common sense. You’re going to pay for the value of what you’re receiving, and that comes in line with everything else that’s parallel to what we talked about: engaging the consumer, transparency of cost and quality of information, wellness programs, etc. As I said before, this is an exciting time to be in health care.
To view 2013 State Healthcare IT Connect Summit speaker Doug Porter, Senior Vice President of Operations & Chief Information Officer for BCBSA register with the HCIT Connect Media portal: http://livevideocast2013statehitcsummit.eventbrite.com