Last month, health insurer Florida Blue partnered with Coral Gables, Fla.-based health system Baptist Health South Florida and Miami-based oncology group Advanced Medical Specialties to form an accountable care organization aimed at providing care for cancer patients in South Florida. The group is the first oncology ACO in Florida and one of the first oncology ACOs in the nation.
Jonathan Gavras, MD, chief medical officer and senior vice president for Florida Blue, shares insight into the process of forming that oncology ACO, some of the challenges in getting it started and the ACO's plans moving forward.
Question: What was the impetus for forming an oncology ACO?
Dr. Jonathan Gavras: Oncology costs nationwide, and particularly in the state Florida, are a major driver of healthcare costs. We had been looking at how to best improve quality outcomes and try to control the increasing trend in medical costs around oncology care. We were working with Advanced Medical Specialists, a quality medical group, and looking at some solutions and speaking about some things with Baptist Hospital. It turned out the three of us got together and thought we'd do something around oncology.
The three of us sat down at a table and said 'let's do something really different.' This is an issue for all of us in the state of Florida. Advanced Medical wanted to promote best quality medical care; Baptist is a very high quality facility that has a lot of cancer care provided within it. As the largest payor in the state, we at Florida Blue thought it was a great opportunity to do something different and to affect the patient experience, patient outcomes and address cancer care in Florida.
Q: How did Florida Blue decide to partner with Baptist Health and Advanced Medical Specialties?
JG: It kind of evolved together. For ACOs to be successful, you really need alignment of the leadership. Our CEO sat down with the CEO of Baptist and the head of Advanced Medical Specialists oncology group, Leonard Kalman, MD. Everybody bought into the process, committed to the process and realized each partner would need to be invested in the ACO to make it work. We realized it was going to take a lot of transparency of information that traditionally hadn't been shared among our three entities ever before.
I think the fact that Baptist is a non-for-profit and Florida Blue is not-for-profit, and we're working with a physician group that has been very successful, means we've been able to come together and align our vision and mission.
Not everybody can do this. You definitely have to have alignment of leadership.
Q: Have other oncology groups, insurers or hospitals across the nation been in touch with you for advice on forming an oncology ACO?
JG: We've gotten so much interest about this from all over the country. It seems like people have had a very hard time getting oncology ACOs started.
The interest has been amazing. We've heard from other health plans, other hospitals and quite a few oncology groups.
Q: How does your ACO determine payments?
JG: Base payments really haven't changed yet. Payment changes will first be based on quality outcome measurements that both the physician group and the hospital will have to meet. Once they meet those goals and targets, there will be a shared savings agreement in place.
Q: What are the quality or cost benchmarks to trigger the ACO incentives?
JG: There are measurements that CMS has in place and other benchmarks at Baptist hospital. Then, there are very clear quality metrics that have been in place by the medical oncology community, which have been published for quite some time. Advanced Medical is part of U.S. Oncology, which has a very rigorous set of pathways and standards.
Q: What have been the biggest challenges in beginning the ACO?
JG: The real challenge involves data. Once we got past the alignment and building trust, which is very important, we had to deal with the very, very tangible issue of data management. These are extremely analytic-intensive efforts. ACOs need to understand what's driving outcomes and what is driving the cost of care. They also need to attribute membership to treating physicians and understanding who's accountable for what part of a member's care. It is a very labor intensive process. What it makes it more difficult is these are not well-established processes. This is all new stuff. It takes the right analytic talent and rigor to put these programs in place.
Q: Who helped to establish the data management solutions?
JG: Florida Blue handled a majority of it, but there was also analytic input from both the medical group and the hospital.
Q: What is the benefit to patients, and how will they be assigned in the ACO?
Initially, we'll tell patients they are coming into this ACO agreement. They won't notice a big difference initially. Over time though, we're expecting they'll encounter a much more integrated experience between the hospital, health plan and physicians. Part of the mechanism of making this a better experience for the patients is it will be more efficient — there will be less overlap and patients will have much better navigation and guidance over their course of treatment. Hopefully, we'll see better treatment outcomes.
Q: What are the goals of the Florida Blue ACO?
JG: Better patient experience, lower medical cost trends for oncology care and better outcomes.
Q: Where do you see the Florida Blue oncology ACO three years from now?
JG: I see it expanding into other lines of service besides oncology. I see it becoming a quality center, or a center of excellence.
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Jonathan Gavras, MD, chief medical officer and senior vice president for Florida Blue, shares insight into the process of forming that oncology ACO, some of the challenges in getting it started and the ACO's plans moving forward.
Question: What was the impetus for forming an oncology ACO?
Dr. Jonathan Gavras: Oncology costs nationwide, and particularly in the state Florida, are a major driver of healthcare costs. We had been looking at how to best improve quality outcomes and try to control the increasing trend in medical costs around oncology care. We were working with Advanced Medical Specialists, a quality medical group, and looking at some solutions and speaking about some things with Baptist Hospital. It turned out the three of us got together and thought we'd do something around oncology.
The three of us sat down at a table and said 'let's do something really different.' This is an issue for all of us in the state of Florida. Advanced Medical wanted to promote best quality medical care; Baptist is a very high quality facility that has a lot of cancer care provided within it. As the largest payor in the state, we at Florida Blue thought it was a great opportunity to do something different and to affect the patient experience, patient outcomes and address cancer care in Florida.
Q: How did Florida Blue decide to partner with Baptist Health and Advanced Medical Specialties?
JG: It kind of evolved together. For ACOs to be successful, you really need alignment of the leadership. Our CEO sat down with the CEO of Baptist and the head of Advanced Medical Specialists oncology group, Leonard Kalman, MD. Everybody bought into the process, committed to the process and realized each partner would need to be invested in the ACO to make it work. We realized it was going to take a lot of transparency of information that traditionally hadn't been shared among our three entities ever before.
I think the fact that Baptist is a non-for-profit and Florida Blue is not-for-profit, and we're working with a physician group that has been very successful, means we've been able to come together and align our vision and mission.
Not everybody can do this. You definitely have to have alignment of leadership.
Q: Have other oncology groups, insurers or hospitals across the nation been in touch with you for advice on forming an oncology ACO?
JG: We've gotten so much interest about this from all over the country. It seems like people have had a very hard time getting oncology ACOs started.
The interest has been amazing. We've heard from other health plans, other hospitals and quite a few oncology groups.
Q: How does your ACO determine payments?
JG: Base payments really haven't changed yet. Payment changes will first be based on quality outcome measurements that both the physician group and the hospital will have to meet. Once they meet those goals and targets, there will be a shared savings agreement in place.
Q: What are the quality or cost benchmarks to trigger the ACO incentives?
JG: There are measurements that CMS has in place and other benchmarks at Baptist hospital. Then, there are very clear quality metrics that have been in place by the medical oncology community, which have been published for quite some time. Advanced Medical is part of U.S. Oncology, which has a very rigorous set of pathways and standards.
Q: What have been the biggest challenges in beginning the ACO?
JG: The real challenge involves data. Once we got past the alignment and building trust, which is very important, we had to deal with the very, very tangible issue of data management. These are extremely analytic-intensive efforts. ACOs need to understand what's driving outcomes and what is driving the cost of care. They also need to attribute membership to treating physicians and understanding who's accountable for what part of a member's care. It is a very labor intensive process. What it makes it more difficult is these are not well-established processes. This is all new stuff. It takes the right analytic talent and rigor to put these programs in place.
Q: Who helped to establish the data management solutions?
JG: Florida Blue handled a majority of it, but there was also analytic input from both the medical group and the hospital.
Q: What is the benefit to patients, and how will they be assigned in the ACO?
Initially, we'll tell patients they are coming into this ACO agreement. They won't notice a big difference initially. Over time though, we're expecting they'll encounter a much more integrated experience between the hospital, health plan and physicians. Part of the mechanism of making this a better experience for the patients is it will be more efficient — there will be less overlap and patients will have much better navigation and guidance over their course of treatment. Hopefully, we'll see better treatment outcomes.
Q: What are the goals of the Florida Blue ACO?
JG: Better patient experience, lower medical cost trends for oncology care and better outcomes.
Q: Where do you see the Florida Blue oncology ACO three years from now?
JG: I see it expanding into other lines of service besides oncology. I see it becoming a quality center, or a center of excellence.
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