The national health care landscape is changing, and BlueCross BlueShield of Tennessee is changing with it.
In order to remain on the forefront of innovative health care practices, we are shifting from traditional fee-for-service payment models to more innovative methods. Our models center on performance measurements, care coordination and provider incentives, with the ultimate goal of ensuring members receive quality, whole-person care.
Accountable Care Organizations (ACO) are coordinated health care providers who are accountable to patients and third-party payers for providing a care that is appropriate and efficient.
These organizations help keep health care costs lower by offering providers financial incentives for avoiding unnecessary tests and procedures. Providers also encourage patients to receive preventive care – ultimately resulting in healthier patients and fewer medical expenses.
ACO Providers are given an annual budget to cover all the patient’s medical costs. The budget is based on the patient’s medical history. If providers are under-budget, the leftover money may go back to the insurance company, the provider or even the patient – depending on the plan.
The goal of these programs is simple: Keeping a patient healthy in the long term rather than on solely treating instances of sickness will help reduce the long-term cost of health care and will increase coordination among a patient’s providers.
Methodist Healthcare in Memphis is our flagship ACO. We plan to add one ACO per year.