The ambulatory surgery center community has been hoping that accountable care organizations, under pressure to save money, would steer more patients to lower-cost, high-quality ASCs, but so far it hasn't worked out that way, and Advocate Health Care's contract with Blue Cross Blue Shield of Illinois is a case in point.
The Illinois Blues agreement, which started in Jan. 2011, incorporates several ACO-like strategies to improve quality and lower costs, but it will not alter Advocate physicians' use of ambulatory surgery centers, says Carrie Nelson, MD, medical director for special projects at Advocate Physician Partners, a contracting joint venture between the 10-hospital Advocate system and 3,900 physicians on staff at those hospitals.
"There are no restrictions on patients going to ASCs and neither is there any added incentive to use ASCs," Dr. Nelson says of the new arrangement, called AdvocateCare, which involves patients in the Illinois Blues' PPO network. She emphasizes that there are no barriers for Blues members in using any ASC in the insurer's PPO network.
Manager of Advocate's JV ASCs still hopes for more volume
However, the manager of Advocate's three joint-venture ASCs is still hoping that Advocate caregivers will steer more patients to his facilities. "As the lowest-cost provider of outpatient surgery available to the Advocate Medical Group, it stands to reason that Blue Cross referrals from this group should be on the rise," says Ronald P. Ladniak, president of Midwest Surgical Management Group, which manages the three centers, which are jointly owned by Advocate and physicians.
"More specific details as to the scope of additional business this will represent and the inner workings of the relationship between Advocate and its joint-venture surgery centers are still being developed," Mr. Ladniak adds.
But Dr. Nelson says the current three-year contract with Blue Cross for AdvocateCare does not mention referrals to ASCs, and the program does not attempt to control referrals to a particular type of provider. "We learned back in the 1990s that HMOs and gatekeepers don't work," she said, referring to arrangements that tasked primary care physicians to control referrals to specialists and choice of facility.
Although Advocate has been called a "shared savings" model, both Advocate and the Blues are not revealing how shared savings payments would be calculated or whether the health system might be rewarded, if at all, for referrals to less expensive ASCs. Dr. Nelson says specifics of the agreement cannot be revealed.
Dr. Nelson says AdvocateCare seeks to improve quality and also to coordinate care in such a way as to reduce waste in the system. Some 65 Advocate care managers, mostly nurses, are working closely with patients who have chronic condition to make sure they get the treatment they need.
She says AdvocateCare is an outgrowth of Advocate Physician Partners' Clinical Integration Program, which has been operating for seven years. "The main focus of the CI program in general involves a collaboration amongst the Advocate Physician Hospital Organizations for measuring and improving quality and efficiency of care," she says.
Learn more about Advocate Physician Partners.
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