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Date/Time
Date(s) - Wednesday, September 09, 2015, 3:00 PM - 4:30 PM

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Learning Objectives

  • Hear updates on the activities of the LAN Guiding Committee
  • Learn how a large insurer, a physician group, and a hospital system are collaborating on a virtual accountable care organization (ACO)
  • Discover how these organizations improve quality, cost, and service

Description

Since its last webinar, the Guiding Committee (GC) of the Health Care Payment Learning & Action Network (LAN) held a conference call to review progress and developments for each of the LAN’s three work groups. In other news, the Alternative Payment Model Framework and Progress Tracking (APM FPT) Work Group held its first in-person meeting on Thursday, August 27, to develop recommendations for categorizing alternative payment models (APMs). GC Co-Chair Mark Smith will share updates on these activities during this webinar.

The webinar will also feature a discussion of how a large insurer (Blue Shield of California), a physician group (Hill Physicians Medical Group), and a hospital system (Dignity Health) are collaborating on a virtual accountable care organization (ACO) model for approximately 41,000 employees who receive coverage through the California Public Employees’ Retirement System (CalPERS). These organizations share information and coordinate care to improve quality, cost, and service. Disease management, pharmacy, improved communication, and palliative care all play a role in this model. Hear perspectives from Kristen Miranda, Senior Vice President, Strategic Partnerships and Innovation of Blue Shield of California; Rosaleen Derington, Chief Medical Services Officer of Hill Physicians Medical Group; and Cheri Galt, Director, Managed Care of Dignity Health.

Agenda

  • Welcome and Opening Remarks – Anne Gauthier, Mark Smith
  • Guiding Committee Updates and Q&A – Mark Smith
  • Panel: Sharing of Large Health System Population Health Virtual ACO Approach – Kristen Miranda, Rosaleen Derington, Cheri Galt
    • Introduction
    • About the ACO Model
    • ACO Model Results
    • Lessons Learned
  • Questions from LAN Participants – Anne Gauthier
  • Upcoming LAN Activities and Closing Comments – Anne Gauthier, Mark Smith

Event Recap

On September 9, 2015 the LAN came together to discuss lessons learned from a virtual accountable care organization (ACO) approach to health care payments. Rosaleen Derington of Hill Physicians Medical Group (HPMG), an organization publicly acclaimed as one of the oldest, largest, and most exemplary ACOs in the country, shared the key elements of HPMG’s ACO model and governance structure. Kristen Miranda of Blue Shield of California (BSCA) provided an overview of BSCA’s ACO start-up costs, along with the forces leading to the development of their ACO model. Cheri Galt of Dignity Health described her organization’s ACO structure, including the factors driving the model’s sustainablity. Each presenter described how their individual ACO models have ultimately translated into overall cost savings and improved quality. The presenters also described the barriers they each faced in the process. The panel addressed questions and comments that touched on how their ACO payment models accommodate advanced-practice nurses, drug-prescription methods including prescription cost-sharing, and health consumer incentives.

Special Note

In place of a follow-up Q&A, our speakers have graciously provided us with access to both an article and a blog from HealthAffairs that they believe are beneficial resources for this topic.

Audio Slides

Mark D. Smith, MD, MBA, serves as Co-chair of the Health Care Payment Learning & Action Network’s Guiding Committee. He is Visiting Professor, University of California at Berkeley, and Clinical Professor of Medicine, University of California at San Francisco. He was the Founding President and former Chief Executive Officer of the California HealthCare Foundation (CHCF). Previously, Dr. Smith was Executive Vice President at the Henry J. Kaiser Family Foundation, where he oversaw programs in HIV, reproductive health, and the health care marketplace. He has also been a faculty member at the Johns Hopkins Schools of Medicine and of Public Health and an elected member of the Institute of Medicine (IOM) in 2001 and chair of the IOM’s Committee on the Learning Healthcare System.

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