Advocate Physician Partners' Contract Strategy Promotes Value Over Volume
Anticipating the advent of accountable care organizations, Advocate Physician Partners (APP) has crafted a value-based payment contract on its strong foundation of clinical integration.
Advocate is entering the second year of this contract with Blue Cross Blue Shield of Illinois (BCBSIL), explained Carrie E. Nelson, MD, MS, FAAFA, APP’s medical director for special projects. The contract continues APP’s mission of aligning quality and incentives, she noted during a recent webinar, Bending the Cost Curve with a Commercial Value-Based Payment Contract: A Case Study from Advocate Physician Partners.
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APP is a care management and managed care contracting joint venture between 10 Advocate hospitals and more than 4,000 physicians. In what has been referred to as the largest clinical integration program and ACO in the nation, APP physicians are evaluated and incented on about 156 clinical measures.
APP’s strategic framework is built on a platform of care coordination, data and analytics. This philosophy has necessitated a cultural shift among APP physicians toward delivering value over volume, as well as a new “mental model. ” For example, APP encourages its providers to think not in terms of hospital discharges, but of transitions.
Advocate is “trying to move to a mindset that focuses more on how we can enable smoother transitions, so that we don’t have a perception that somehow we’re just dumping the patient off into another environment and its someone else’s job to make sure that the care is delivered effectively,” explained Dr. Nelson.
Choosing to expend its energies on the top 2 to 5 percent of heavy utilizers, APP relies on care coordinators across the continuum, from case managers embedded in physician practices on the outpatient side to “SNF-ists” who work with advanced practice nurses to decrease readmissions and achieve appropriate lengths of stay by SNF patients.
To get physicians on board with this premise, APP relies on a combination of “data and success stories,” she added.
Moving forward in the contracting process, APP would like to see more data on patients who go out of network to seek care, and specifics on where they seek care, so APP can try to bring them back in-network.
APP will also recalibrate its embedded care management model, with the intention of substituting telephonic case management support in certain instances. Advocate will also zero in on the hospital stay, which it sees “as the biggest business opportunity, even compared to ED overuse,” Dr. Nelson notes.
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