Two of the Triangle’s biggest health care organizations have teamed up to trim medical expenses as part of a broader national emphasis on cutting costly waste in the health care field.
Blue Cross and Blue Shield, the state’s biggest insurer, will work with WakeMed Key Community Care to prevent excessive hospitalizations and other inefficiencies. WakeMed Key Community Care is an Accountable Care Organization, or ACO, involving WakeMed Health & Hospitals, and Key Physicians, an affiliation of more than 200 doctors in the Triangle.
The ACO approach to health care involves regular oversight of patients after they leave the hospital or the doctor’s office to ensure they are taking medications and following their prescribed regimen.
Blue Cross is participating in two major ways. First, the Chapel Hill insurer will provide the ACO doctors offices with internal utilization reports so that they know what services patients are using and billing for insurance. Such insurance records are typically proprietary and will give WakeMed and Key Physicians a more complete picture of its patients’ health care history.
Blue Cross will also contribute financially to help WakeMed Key Community Care hire staff that will coordinate patient care. Typically, the staff closely monitors and stays in contact with patients to prevent complications and other costly developments.
The partnership is Blue Cross’ sixth contract with an ACO in North Carolina since 2012. One of the early contracts in 2012 was with Key Physicians. The contract announced this month replaces the 2012 contract and expands the collaboration.