Lifespan, BCBSRI Ink Accountable Care Deal

Jun 25, 2014

The state’s largest hospital chain and largest insurer have inked an agreement to share patient data that will help them look for ways to improve health and save money. The deal is the largest of its kind in the state and could shape health care for more than 35,000 Rhode Islanders.

Here’s how this will work: Blue Cross and Blue Shield of Rhode Island will share claims data on a group of patients (for now, it's 35,000 at about 110 primary care practices). Together with Lifespan, they’ll comb through that data to learn more about how patients with certain diagnoses are being cared for, and then find ways to improve it. The idea is that if you can help patients with diabetes, for example, get their blood sugar under control in the community, you can avoid more costly treatments, like a hospital stay. How? Lifespan executive Karen Rosene Montella explained. Say, for example, that out of a group of patients with diabetes, about 60% are having trouble keeping their blood sugar under control.

“For example and you look at that 60% that are not well controlled, and you realize those are all, for example, people who work very traditional working hours," said Montella. "Then you redesign your care delivery to say, ‘OK, these are people who will need to be seen earlier in the morning, later in the day, there will need to be some more phone communication.’”

Lifespan and Blue Cross will offer support to primary care doctors in redesigning that care, and then pay them based on that new model.

Lifespan's Mark Proto said it's about identifying gaps in patient care, "and filling those gaps in care, which will hopefully result in better outcomes and prevention of longer-term, higher cost health services down the road.”

Proto said the agreement shifts the way doctors are paid, from a fee for service model to one that rewards them for quality.