Kansas’ Largest Insurer And Health Care Provider Agree To New Payment Model

Kansas’ largest health insurer and the state’s largest health care provider are forming an accountable care organization to lower health care costs.

After nearly a year of negotiations, Blue Cross and Blue Shield of Kansas and Wichita-based Via Christi Health have finalized an agreement aimed at changing the way care is provided to approximately 20,000 Kansans covered by BCBS policies.

Under the agreement, Via Christi would share in any savings that result from an emphasis on preventive care and from more effective management of patients with chronic conditions. But it could also lose money if the anticipated savings don’t materialize.

The arrangement creates financial incentives to move away from doing tests and procedures that inflate health care costs without improving the quality of care, says Mary Beth Chambers, a spokesperson for BCBS of Kansas.

“It really creates kind of a new type of partnership between the insurer and the health care provider,” Chambers says.

The belief — buttressed by research — that an increased focus on preventive care and management of chronic conditions can lower overall health care costs has led networks of doctors and hospitals across the country to form hundreds of accountable care organizations, or ACOs.

“What makes our ACO unique in our service area is that it’s a physician-led payer-provider model,” Gambino says. “Working together allows us to create wins for everyone involved.”