RIVERSIDE – Patients whose physicians belong to one of six Inland Empire medical groups that contract with Blue Shield of California can expect to see changes in their healthcare services in the coming months.
Blue Shield is partnering with Redlands-based healthcare consulting firm Epic Management LP to create an Accountable Care Organization that will focus on identifying ways to optimize outpatient treatment programs to rein in health maintenance organization, or HMO, costs, according to a joint statement released by Epic and Blue Shield.
”The goal is to improve quality and efficiency while bringing down healthcare costs,” said Lindy Wagner, a spokeswoman for Blue Shield.
She told City News Service that 10 prior ACOs established in other parts of the state had proved valuable, and the hope is to realize the same value in the Inland Empire.
”This is about making sure the healthcare system works as it should … and people are receiving the right care at the right time,” Wagner said.
The physician groups whose 27,300 patients will be part of the ACO are Victorville-based Alliance Desert Physicians, Redlands-based Beaver Medical Group, Rancho Cucamonga-based Chaffey Medical Group, Rancho Cucamonga-based Pinnacle Medical Group, the Redlands-Yucaipa Medical Group and Temecula-based Tri Valley Medical Group.
According to Blue Shield, 7,000 beneficiaries are covered under the California Employees’ Retirement System, or Calpers, while another 7,500 are covered under plans provided to employees of San Bernardino County government.
Wagner said ACO consultants will be examining a number of factors tied to patient outcomes to see where and what changes are appropriate.
”We don’t know exactly yet what interventions will be necessary,” she told CNS. ”The consultants will be looking at detailed claims history to decide where they can impact change.”
According to the Blue Cross spokeswoman, programs that other ACOs implemented to reduce healthcare costs included shifting patients to generic, as opposed to brand name, drugs, as well as improving transitional care, as when a patient goes from inpatient to outpatient status.
”There’s more emphasis on follow-up to make sure people are not going back to the hospital,” Wagner said. ”The Accountable Care Organization aims to bring down re-admissions and help keep people out of the emergency room. That’s one way to reduce the cost trend.”
The Inland Empire ACO will be active for two years under terms authorized by the California Department of Managed Health Care.