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Meaningful Health Care Informatics Blog

Oct 17 2011   8:53PM GMT

Commercial payers actively investing in ACO and PCMH

Posted by: RedaChouffani
Accountable care organizations, ACO, ACOs, EHR adoption, Health plans, Medical Home, Patient Centered Medical Home, Payer, Payer collaboration, PCMH

For many years, both commercial and non-private payers have engaged physicians in improving patient outcomes through the various pay for performance initiatives. Many of the programs have had monetary incentives associated with them as well as rankings listed for participants. In other cases, payers have sponsored and funded certain initiatives for physicians and associations.

Blue Shield of California, announcing the news on Monday Oct. 17, did just that. They have announced that they would grant nearly $20 million to hospitals and other health organizations to help them participate in an ACO within the state of California.

BS of California had previously participated in three pilot ACOs, and this investment shows a clear interest from a commercial payer for the ACO model to succeed. Private payers are investing more and more in some of these initiatives, as they show improved patient outcomes and reduced costs, which is inline with their business model as it is.

Recently, in North Carolina, Blue Cross Blue Shield of NC invested $15 million in NC Path to provide over 85% subsidy for physicians to cover EHR software and set up costs. NC BCBS, considered one of the largest commercial payers in the state, selected AllScripts as the vendor and partner of choice to roll out the EHR.

In both cases, having commercial payers support the patient centered medical home (PCMH) and ACOs is significant. While there are still many questions around the true costs and if ACOs can be a sustainable model, these types of grants are a good sign for many physicians that PCMH and ACOs are going to be supported from the state, federal and private sectors.


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