THE KEY TO ACCOUNTABLE CARE AND HEALTH CARE REFORM
Population health strategies promote the clinical integration of various health care providers to effectively manage the top 5% of chronically ill patients that are considered high risk and that make up 50% of health care costs.
To effectively manage population health and adapt to the shift in the health care market toward value-based payments and greater provider accountability for quality and cost, BSWQA participates in managed care contract agreements that promote health improvements across patient populations and offer opportunities for shared savings from improved quality of care and reductions in health care costs. With substantial investments in the patient-centered medical home (PCMH) model, care coordination and data analytics complete, BSWQA is implementing population health strategies deemed necessary for successful clinical integration and care delivery focused on predictive, preventive and personalized care.
Over 40,000 lives (and growing) benefit from BSWQA’s established infrastructure. Working collaboratively in an accountable care effort with a multitude of stakeholders (hospital, physicians, postacute care facilities, and other health care providers) across the continuum, BSWQA utilizes fundamental modalities for population health management including, but not limited to comprehensive care coordination, evidence-based, protocol-driven disease management, and standardized, proactive outreach for preventive health services to meet value-based metrics that include improvements in quality, efficiency, cost, and health outcomes.
In September of 2014, Aetna and BSWQA launched an accountable care collaboration through the introduction of an Aetna Whole HealthSM product in North Texas. Aetna Whole Health is a collection of benefit plans designed to give members in Collin, Dallas, Denton, Ellis, Parker, Rockwall, and Tarrant counties access to highly coordinated care from physicians and facilities in the BSWQA. So far two prominent employers in the Dallas/Fort Worth market have included this product in their open enrollment period with over 18,000 members already enrolled. With potential savings between 8-15% in the first year, the Aetna Whole Health collaboration with BSWQA offers employers more value for their health care dollar.
BSWQA is working to further advance its capacity to coordinate patient populations by participating as an Accountable Care Organization (ACO) in the Medicare Shared Savings Program (MSSP) sponsored by the Centers for Medicare and Medicaid Services (CMS). With the needed infrastructure already in place (governance, adequate network, care coordination, information technology), BSWQA’s participation in MSSP will offer visibility into Medicare patient utilization patterns, simplification of Physician Quality Reporting System (PQRS) reporting, and alignment with readmission programs. To date, BSWQA’s MSSP application has potential to include over 60,000 lives.
Our success in managing our patient populations has created heightened awareness among prominent payers and employers in our market to directly contract with BSWQA as their preferred network of providers and facilities.