Blue Shield teams with billionaire to boost ACO technology

Tools

Blue Shield of California wants to make its successful accountable care organization program even "bigger, faster and stronger." Having already addressed the affordability aspect that drove the insurer to create ACOs, and in one case saving $37 million for the CalPERS program, it now has turned its attention toward implementing robust technology to hopefully achieve even greater savings.

In a new partnership announced last week with NantHealth, a health technology company founded by billionaire Patrick Soon-Shiong, Blue Shield will be launching a technology platform across all of its ACOs. It also has formed a new ACO with Access Medical Group and Saint John's Health Center, which will serve as a "continuous learning center" to help drive evidence-based and proactive medicine.

"When we went out to look for a partner for a technology platform for our ACOs, we really looked at the elements that you would ideally need to do well in an ACO to be successful," Simon Jones (pictured), Blue Shield's director of ACO technology and program strategy, told FierceHealthPayer. "That's obviously quite a wide range of things from managing risk to identifying patients that you need to spend the most time with and managing those patients effectively from end to end," he said.

Blue Shield's eight ACO programs throughout the state will be deploying this new IT platform. "They've been very successful with paper, smoke signals, Excel spreadsheets and, frankly, just a lot of very hard work from dedicated people," Jones said. "We want to provide the opportunity to enable technology as much as we can in the current environments."

The "base layer" at the core of this new venture is Blue Shield's aggregation and consolidation of its member data to "provide a 360 degree view of each patient," Jones said. "Today we have a tremendous amount of information inside the four walls of Blue Shield about a member and don't share a fair amount of that with providers when they're providing care because there's no effective mechanism to do so currently."

Then, the IT system can identify patients requiring the most help, for example, those who are chronically ill or have the highest health risks, to help providers create workflows and care plans around individual patients. The system also can "proactively alert" those providers when the patient doesn't complete a needed care activity, such as filling a prescription, receiving an immunization or undergoing a standard screening.

The alert "will serve as a reminder to the patient--hey this is important, please go pick it up," Jones said, adding that it also will help providers reach out to the patient to help determine the barrier to completing the care activity and coming up with a solution to help avoid the problem in the future. Essentially, Blue Shield "is helping provide doctors and nurses with the tool set that allows them to function more effectively and in a more automated fashion," Jones said.

Another key component of the deal is "trying to bake in the evidence-based medicine" so that the workflows and care plans are based on the most recent research available. "The research field moves fairly quickly, so it can be a bit challenging for individual doctors to keep up with everything that's going on," Jones said. In fact, many of Blue Shield's provider partners have been asking for help in determining evidence-based medicine.

That's where the ACO with Saint John's and Access comes in. Acting as the continuous learning center, Saint John's will function as a "continual pilot and test bed to continue to iterate on both processes and technology to figure out how we can do things better," Jones said. It's designed as a multi-year pilot to help Blue Shield, NantHealth and their other partners test technology and improve the clinical processes using that technology, he added.

"Blue Shield and NantHealth came together and said this is our opportunity with two very willing partners to stand up that ACO," he added. "It's really an equal partnership in that we're all at the table together talking about how we're going to steer this." - Dina (@HealthPayer)