Research shows that physician-led Accountable Care Organizations create seven times the savings per Medicare beneficiary compared to hospital-led ACOs. A new partnership aims to advance that.
Health insurer CareFirst BlueCross BlueShield and primary care network Aledade announced Tuesday that they have formed a strategic alliance that will help physician practices in CareFirst’s network improve its value-based care.
In-network practices will have access to support from Aledade’s specialists. This includes on-site coaching and regulatory and policy expertise. In addition, they’ll have access to Aledade’s population health management platform, which is integrated with more than 100 electronic health records. Using this platform will help physicians identify at-risk and high-risk patients.
The two organizations are in a risk-bearing agreement in which both only get paid when they meet affordability, quality and consumer experience targets. The companies’ performances will be evaluated annually, and the amount they are paid depends on how much these targets are improved by, said Brian Wheeler, vice president of provider collaboration and network transformation at CareFirst. He declined to provide specific contract terms of the payment model.
CareFirst and Aledade are tracking three key metrics in their partnership: reducing hospitalizations, reducing readmissions and increasing primary care visits, said Ananya Banerjee, chief commercial officer at Aledade.
“Together, we’re working to improve outcomes, quality, patient experience, and affordability for more patients, while lowering health care costs across the entire system,” Banerjee said in an email.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
So far, Aledade has helped save more than $1.2 billion in its work with primary care practices by improving preventive care and avoiding hospitalizations and emergency department visits, according to a news release.
The news follows another value-based partnership between Aledade and health insurer Humana. This agreement will last 10 years and will give Humana’s Medicare Advantage members access to Aledade’s physicians. Like the strategic alliance with CareFirst, the Humana partnership is also focused on reducing hospitalizations, reducing emergency department visits and increasing primary care utilization, Aledade CEO Farzad Mostashari previously told MedCity.
Aledade has undergone extensive expansion in recent years. The company announced last month it added more than 450 primary care practices to its network for 2023. It now has more than 1,500 practices in its network. It also acquired data analytics company Curia.
By working with CareFirst, Aledade aims to improve the healthcare experience for both patients and physicians, Banerjee said.
“In this partnership, as with all of our partnerships, we want to operate in a way that is good for doctors, good for patients, and good for society,” Banerjee stated. “When we can give clinicians the means to keep their patients healthy and out of the hospital, everybody benefits.”
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