Thursday, September 25, 2014

Health Insurance Outlook

Benjamin Faesel, Capital BlueCross
Senior Manager, Healthcare Reform

Capital BlueCross, St. Luke’s University Health Network bring Accountable Care Arrangement to the Lehigh Valley

Since the inception of the Affordable Care Act (ACA) in 2010, Capital BlueCross has worked diligently on behalf of its customers and the community to implement the many provisions that seek to improve access to healthcare and reduce health care costs. One way the ACA works to enhance access and lower costs is by encouraging healthcare providers and health insurers to collaborate together in Accountable Care Arrangements.

Capital BlueCross has implemented a number of Accountable Care Arrangements throughout central Pennsylvania, and recently announced its first one in the Lehigh Valley, with St. Luke’s University Health Network. Under this model, Capital BlueCross is partnering with St. Luke’s Physician Group primary care and specialist physician practices to provide dedicated nursing resources and technology to deliver patient-centered, holistic care. St Luke’s Physician Group is a network of physician practices affiliated with St. Luke’s University Health Network.

Through an Accountable Care Arrangement, customers with complex and chronic medical conditions or those at risk for such a medical condition will be identified for outreach, education, and clinical, wellness, or community-based intervention services through the use of chronic disease registries, St. Luke’s Physician Group’s electronic medical record system, and Capital BlueCross’ technology-enabled predictive modeling tool. The partnership also will identify customers who are eligible, but have not received, preventive services appropriate for their age and medical condition.

Capital BlueCross and St. Luke’s University Health Network recently issued comments about their new Accountable Care Arrangement in a press release:

“St. Luke’s University Health Network is committed to improving the health, well-being, and quality of life of the people living in our community,” said Dean Evans, President, St. Luke’s Physician Group. “We look forward to working with Capital  BlueCross and business leaders to deliver high quality outcomes to patients in a cost-effective, efficient, and measurable manner.” 

“Capital BlueCross is excited to partner with St. Luke’s, which has a strong reputation of delivering quality care to the Lehigh Valley community,” said Dr. Jennifer Chambers, Capital BlueCross Senior Vice President and Chief Medical Officer. “We have had great success coordinating Accountable Care Arrangements, and look forward to providing this high level of care to our customers through the St. Luke’s network.”

Tom Croyle, President of the Lehigh Valley Business Coalition on Healthcare, also praised the effort, saying, “Employers support efforts to move from a healthcare system paid on volume of services performed to one that’s rewarded for value. This requires serious discussions about changing not just business models and how we pay for health care, but the culture of clinical practices and measures. The Coalition applauds two trusted partners, St. Luke’s and Capital BlueCross, for the approach they have taken and appreciate the opportunity for Lehigh Valley Business Coalition on Healthcare’s input into the process.”

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