By BRIAN DOWLING | The Hartford Courant
Anthem Blue Cross and Blue Shield and St. Vincent’s Health Partners announced Friday a new reimbursement contract for chronic disease patients that is based on outcome and quality of care rather than traditional fee-for-service models.
The agreement — called an accountable-care organization — links St. Vincent’s insurance reimbursements from Anthem to certain metrics related to hyper tension, diabetes, tobacco use and obesity.
Health insurers increasingly are using accountable-care organizations, which often include using electronic medical records and clinical coordinators to follow up on patients. In March, Aetna and ProHealth Physicians Inc., a doctors’ network, announced a similar agreement, the first of its kind in the state.
“Healthcare is being shifted from volume-based reimbursement to value-based reimbursement,” Dr. Thomas A. Raskaukas, chief executive of St. Vincent’s Health Care Partners, said in an interview.
To do this, Bridgeport-based St. Vincent’s will increase patient follow-ups, for instance, making sure they get their medication or receive preventative treatments. The healthcare group will also examine service trends to see where treatments, varying in method or price, produce similar outcomes. A major target is to avoid hospital readmissions and emergency room visits.
“The goal is to improve the fractionated care that goes on by having more coordinated care and by looking at outcomes and quality metrics,” Raskaukas said.
Anthem and St. Vincent’s will share in savings from the program, the groups said in a joint statement.
Dr. Peter Power, Anthem’s chief medical officer, said in a written statement: “As Connecticut’s largest commercial health insurer, we believe we have a unique opportunity to use our size, scope, and experience to bring about substantive improvements in health care delivery that will benefit people in Connecticut,” added Dr. Bowers.
Courant Staff Writer Matthew Sturdevant contributed to this report.