Hill Physicians Medical Group has launched 3 ACO collaborations. Beginning as a pilot in 2009, an ACO was formed between Hill Physicians, Blue Shield of California and Dignity Health for the CalPERS population in Sacramento. The integrated health care delivery model aligned incentives among the health plan, hospital system, and medical group with the goal of keeping healthcare premium costs flat. Each organization shares clinical and case management information in order to tightly coordinate care.
As part of their ACO-model of care, Hill Physicians have built upon their PCMH Initiative. They have redesigned the inpatient discharge workflow to close the gap between inpatient and outpatient care, leveraged Skilled Nursing Units, In-Home Medical Management and other services to reduce unnecessary Emergency Room visits, and have begun transforming selected practices into Patient Centered Medical Homes. Within the PCMH model, care providers work in physical teams as well as across virtual medical neighborhoods to coordinate care, especially for patients with chronic conditions like hypertension, diabetes and congestive heart failure.
Each year, an annual budget is set based on a global per-member, per-month (PMPM) cost target for five categories: facility services, professional services, mental health services, pharmacy, and ancillary services. Targets are set at a level that reflects the partners' commitment to reducing costs below current trends.
Blue Shield of California (December 2015)
Blue Cross Blue Shield Industry Report (2012):
Health Affairs (September 2012):
Noteworthy examples include achieving 67% HbA1c testing mong diabetics, with 77% demonstrating control within clinically accepted standards. Additionally, sharpening our focus on women’s health, we set a target of achieving over 76% compliance in breast cancer screening among those due for a mammogram. We achieved 79% compliance.
Blue Shield of California (December 2015)
Health Affairs Blog (April 2014):
Blue Cross Blue Shield Industry Report (2012):
Health Affairs (September 2012):