Blue Shield of California gives $20M in ACO help

By Bernie Monegain
09:58 AM

Eighteen California hospitals, health systems, clinics and physician groups -- many of them catering to underserved populations -- will receive grants totaling nearly $20 million from Blue Shield of California to help them participate more effectively in accountable care organizations (ACOs).

The ACO grants are being made as part of Blue Shield's 2 percent pledge, a commitment the company made last June to limit annual net income to 2 percent of revenue and to return the difference collected above that amount to customers and the community. The grants, announced Oct 17, represent an average of $10 million for each of the two fiscal years (2010 and 2011) that the pledge has been applied.

Blue Shield currently participates in three ACOs in Sacramento and San Francisco covering 70,000 HMO members. It has plans for additional collaborations in Orange and Stanislaus counties aimed at delivering integrated, cost-efficient care to 38,000 members. ACOs are a key part of delivery system reforms included in the Affordable Care Act.

"We received nearly 60 grant applications from providers around the state,” said said Paul Markovich, executive vice president and chief operating officer, Blue Shield of California. “This demonstrates overwhelming interest among providers in collaborating to reduce costs and enhance the quality of care.
Markovich noted that among those receiving grants are a community clinic serving safety net populations, the largest independent Federally Qualified Health Center in the nation, several entities seeking to better manage patients with chronic diseases such as diabetes, and two children's hospitals.

AltaMed Health Services Corporation, which serves Latino, multi-ethnic and uninsured populations in Los Angeles and Orange Counties, will apply its $1 million grant to improve clinical integration with its Accountable Care Network hospital partners. "We thank Blue Shield of California for supporting our vision of improving access to care for the safety net population,” said Castulo de La Rocha, president and CEO of AltaMed. “This grant will greatly accelerate our ability to enhance continuity of care, manage post-discharge care of patients, and enhance coordination of care among the communities we serve."

See the next page for a list of the grantees, their awards and their plans.

Grantees and their projects

  • The Greater Los Angeles Care Innovation Corridor, $300,000, Southern California. Develop a seamless system of care and coverage that would lower annual costs of care, enable consistent delivery and transparent reporting around quality and safety, and implement an interoperable health information exchange
  • Physicians Medical Group of Santa Cruz, $475,000, Greater Bay Area. Create a real-time care management tracking system that would help reduce bed days, emergency room visits and readmissions while increasing post-discharge follow-up, complex case management, care coordination and data sharing
  • Greater Newport Physicians & Hoag Memorial Hospital Presbyterian, $643,610, Southern California. Develop an ACO that would feature a diabetes medical home intended to move 25 percent of diabetes patients to controlled status and deliver significant yearly cost savings
  • Doctors Medical Center of Modesto, $650,000, Central California. Deliver a post-acute discharge program that seeks to reduce post-discharge re-admissions and emergency room visits, improve primary care follow up, and reduce overall length of stay
  • Share Our Selves (SOS), Comprehensive Care Solutions, $750,000, Southern California. Implement the Integrated Continuum of Care Project to increase coordination with hospital partner and ultimately reduce length of stay, readmissions and emergency room use. Serves safety net population. HealthCare Partners Affiliates Medical Group, $835,000, Southern California - Develop interventions that improve coordination of hospital care and incentivize high-risk Medicare patients who suffer from chronic diseases such as diabetes to become more involved in their own care management.
  • Chinese Community Health Care Association, $971,000, Greater Bay Area. Improve electronic laboratory ordering and reporting, develop care coordination initiative, and implement electronic health record system enhancements. Serves Asian and safety net populations
  • Huntington Memorial Hospital, $980,000, Southern California. Advance initiatives designed to decrease readmissions and emergency room use while promoting medical adherence.
  • Adventist Health, $1,000,000, Northern Central California and Southern California. Integrate physicians and three rural hospitals to reduce readmission and emergency room utilization and enable timely follow-up, referrals, care coordination and electronic prescriptions. Serves rural population.
  • AltaMed Health Services Corporation, $1,000,000, Southern California. Implement a Health Information Exchange to share data and an evidence-based Medical Management and Care Transitions Model to help reduce avoidable admissions, length of stay, and service duplication for the patients of the largest independent Federally Qualified Health Center in the nation. Serves Latino and safety net populations
  • Community Hospital of the Monterey Peninsula, $1,000,000, Greater Bay Area. Implement an ambulatory electronic health record for 150 physicians, adopt a community health information exchange for 100 physicians and 50,000 patients, and develop an information technology strategy to integrate clinical and claims data
  • Children's Hospital of Orange County, $1,040,000, Southern California. Provide family-centered medical homes, case and disease management services, health educators, nutritional and social service advice and member services. Serves safety net and pediatric populations
  • Facey Medical Foundation and Medical Group, $1,097,750, Southern California. Establish an ACO including a medical home and care transitions model intended to reduce bed days, admissions, readmissions and emergency room use while increasing post-discharge provider visits, palliative care, home provider visits and hospice referrals
  • Children's Hospital Los Angeles, $1,130,000, Southern California. Expand pediatric medical home models and implement improved care coordination and case management, utilization management, quality improvement monitoring measures, an enhanced information technology platform linking providers, a more effective provider network, and the ability to accept and manage bundled payments. Serves pediatric population
  • Brown & Toland, $1,700,000, Greater Bay Area. Create a local health information exchange to connect with other such exchanges locally and regionally and with other enterprise or stand-alone electronic health records, including small physician offices
  • Hill Physicians Medical Group and Catholic Healthcare West, $1,800,000, Northern California. Implement a tactical plan focused on high-risk patient analysis, avoidable day management, and emergency room management
  • St. John's Health Center, $2,000,000, Southern California. Implement quality improvement program to achieve clinical integration among participating physicians, increase patient satisfaction, enable timely medical records, and increase use of generic drugs while decreasing readmissions and avoidable days
  • St. Joseph Health System, $2,000,000, Southern California. Implement the expansion of electronic health records, case management, utilization cost management, risk stratification and predictive modeling as well as to better manage outcomes and introduce preventative outreach services.

The grants total $19,372,360. The remaining funds are set aside as a reserve for unexpected needs of the grantees and to monitor and evaluate implementation of the grants.