Blue Cross and Blue Shield of Georgia members who use Emory Healthcare are now able to tap into a new type of coordinated care that the two organizations say can improve the quality of medical services offered while lowering costs.
Georgia’s largest health system and its largest insurer have partnered to form an accountable care organization. ACO networks, not yet well-known, are growing in number across the country.
ACOs are integrated networks of hospitals, physicians and other providers who work together to care for patients. Those who get care through the new ACO will be able to use doctors employed by Emory as well as participating private practice physicians throughout the state.
Under ACOs, patients can still see their regular doctor at no extra cost, even if that doctor is outside the ACO network. But the patient wouldn’t get the benefits of coordinated care.
In an ACO, patients rely on a primary care doctor in the network to coordinate the care provided by a team of health care professionals, including specialists who also work in the network. It amounts to one-stop shopping for patients seeking medical care.
Information on patients is shared electronically so that they receive the appropriate care that is needed as soon as it’s needed, the organizations said.
ACO advocates say this can help the patient avoid future complications that require hospital and emergency room trips. It also can prevent the duplication of services. Both can lead to higher health care costs and poor quality care.
“The notion is that this is the way to achieve more affordable care, a way to squeeze out some of the waste and inefficiencies,” said Bill Custer, a health care policy expert at Georgia State University.
John Fox, president and CEO of Emory Healthcare, said, “More and more organizations are trending towards partnerships like these because of the direct benefits for everyone involved, most importantly our patients.”
Some critics have said the financial incentives ACO providers can earn by holding down costs could lead to a greater emphasis on saving money and less on providing the best care.
In an effort to lower costs, doctors and hospitals in ACOs are rewarded for providing quality care at lower cost than in the traditional fee-for-service system. In the latter, providers are rewarded for the volume of services they render, such as how many medical tests are ordered. That can drive up costs.
About the Author
Keep Reading
The Latest
Featured
