ACO NEWS from the MAX

North Shore-LIJ partners with Empire BCBS on ACO agreement
North Shore-Long Island Jewish Health System (Great Neck, NY) signed an accountable care agreement with Empire Blue Cross Blue Shield (Albany, NY) to cover more than 33,000 commercial and Medicare Advantage members. North Shore-LIJ will coordinate care through North Shore-LIJ Premium, an integrated network of over 5,500 primary care and specialty physicians as well as other healthcare professionals in the New York metropolitan area. The ACO will work with North Shore-LIJ Clinical Integration Network IPA, the health system’s Premium Network, and North Shore-LIJ Care Solutions, its care management enterprise, to engage physicians to manage high-risk patients covered under this program.

Cigna HealthCare forms ACO with PrimeHealth Physicians
Cigna HealthCare Inc (Bloomfield, CT) formed an ACO with PrimeHealth Physicians (Miami, FL), a physician-owned group of independent primary care providers. Through Cigna’s Collaborative Care program, 45 PrimeHealth providers will work to coordinate care for roughly 5,300 Cigna members, especially those with chronic conditions, in order to reduce costs and improve outcomes. Participating physicians will also be rewarded under a pay-for-value reimbursement structure. The ACO took effect in July 2015.

Virginia Cancer Institute forms ACO with Cigna Healthcare to improve cancer treatment
Virginia Cancer Institute (VCI) (Henrico, VA) formed an ACO with Cigna HealthCare Inc (Bloomfield, CT) to improve treatment and care for cancer patients. The program will help improve affordability for patients and customer experience for Cigna members. Cigna’s single point of contact will collaborate with VCI’s oncology care coordinator on customer benefits and will also provide case management services to help patients and their families make informed decisions regarding treatment and planning options.

Illinois Bone & Joint Institute, Cigna form ACO
Illinois Bone & Joint Institute LLC (IBJI) (Arlington Heights, IL) and Cigna Healthcare Inc (Bloomfield, CT) formed an ACO to improve quality and lower cost of care. IBJI is participating in Cigna Collaborative Care, a value-based model that uses incentives to engage healthcare professionals and helps drive affordability, improved health, and customer experience. IBJI will also be eligible to earn a “pay for value” incentive.

Trenton Health Team certified as Medicaid ACO in three-year pilot program
Trenton Health Team ACO (THT) (Trenton, NJ) was certified by the New Jersey Department of Human Services (Trenton, NJ) as one of the first Medicaid accountable care organizations (ACO) in the state, serving the greater Trenton community. The ACO pilot is for a three-year period effective July 1, 2015. The organization encompasses the majority of primary and specialty care providers through Saint Francis Medical Center (Trenton, NJ), Capital Health (Trenton, NJ), Henry J Austin Health Center (Trenton, NJ) and the City of Trenton Department of Health & Human Services (Trenton, NJ) in a shared effort to transform healthcare for the community. To improve coordination of care, THT established the Trenton Health information Exchange (HIE), a shared database that allows doctors and other providers to communicate directly about patient needs. Saint Francis Medical Center is owned by Trinity Health (Livonia, MI).

Privia Quality Network ACO partners with Shenandoah IPA, becomes largest Mid-Atlantic ACO
Privia Health LLC (Arlington, VA) announced a strategic partnership with Shenandoah Independent Practice Association Inc (SIPA) (Winchester, VA), a clinically integrated independent physician network comprised of over 400 physicians serving patients in northern and western Virginia. Under the terms of the partnership, Privia Quality Network ACO LLC (Arlington, VA) will become the exclusive contracting entity for all performance-based arrangements and clinical integration initiatives in which SIPA providers participate. Privia has assumed responsibility for SIPA’s ACO, and the co-presidents of SIPA, Curtis Winter and Vashali Geib, joined Privia as regional VPs. The partnership between the two entities is effective immediately.

Maryland Dept of Health & Mental Hygiene to launch ACO-like model for patients with dual eligibility
The Maryland Department of Health & Mental Hygiene (DHMH) (Baltimore, MD) will launch a pilot ACO-like model for individuals dually enrolled in Medicaid and Medicare who live in Baltimore City. The Dual Eligible ACO will operate on a shared savings model with savings targets and quality of care benchmarks focused on coordination of primary, acute, and long-term care. The goal is to scale the model statewide after the pilot outcomes are analyzed. The pilot was the focus of MD’s State Innovation Model (SIM) design proposal. The SIM program was awarded $2.5 million in funding from CMS (Baltimore, MD) funding in December 2014. DHMH released a request for proposals in May 2015 seeking a contractor to provide support and develop the shared savings model, a quality alignment and measurement plan, a provider-organization engagement strategy, a dual eligible enrollment strategy, and a lead entity and governance structure.

Healthy Greater Newark ACO certified as Medicaid ACO
Health Greater Newark ACO (Newark, NJ) was certified as a Medicaid ACO by the New Jersey Department of Human Services (NJDHS) (Trenton, NJ). The ACO, formed in July 2014, was created and managed by the Greater Newark Healthcare Coalition (Newark, NJ), a collaboration of healthcare system leaders, community health advocates, social services representatives, university delegates, and others to address primary care for the poor and medically underserved. The ACO serves Newark, New Jersey, which has the largest populations in the state under the poverty level that are Medicaid eligible.

University Hospitals (OH) forms second ACO with Anthem BCBS
University Hospitals (UH) (Cleveland, OH) and Anthem Blue Cross & Blue Shield of Ohio (Cincinnati, OH) launched an ACO initiative to manage the care of the insurer’s Medicare Advantage members. The ACO will operate similarly to UH’s other ACO efforts, in which physicians coordinate care and use patient navigators to improve outcomes and reduce costs. UH had previously formed an ACO with Anthem in 2014, though it focused on commercial plan members.

St Francis Health (DE) partners with Medical Society of Delaware on new MSSP ACO
Saint Francis Healthcare Services (Wilmington, DE) will partner with the Medical Society of Delaware’s (MSD) (Wilmington, DE) subsidiary MedNet to form Delaware Care Collaboration (DCC) (Newark, DE), a physician-driven Medicare Shared Savings Program (MSSP) ACO. Scheduled to launch January 1, 2016, DCC will improve the patient experience while providing access to high-value medical care through a coordinated, patient-centered approach. Primary care physicians who are either employed or in private practice in Delaware can join. Unlike many ACOs, Delaware Care Collaboration will not require any financial investment from participating physicians, but will provide physicians with transition assistance, navigation and care coordination services, sophisticated and meaningful analytics, and hands-on educational support. To date, 22 physicians have enrolled.

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