Dr. Eduardo Sanchez, vice president and chief medical officer for the insurer said quality measures for preventive services, chronic disease management and hospital-acquired infections were among the types of measures under consideration.
Sanchez said the agreement would be the Texas Blues' first ACO contract, thought the insurer is in talks with other health systems.
The deal would join a growing number of accountable care contracts among commercial payers, hospitals and medical groups, which have flourished as federal efforts to promote the new payment model have led to a rising number of ACOs under Medicare. Hospitals and physicians in ACOs may earn bonuses or receive penalties tied to performance on quality and cost control measures. Last week, Medicare said it added more than 100 accountable care contracts to roughly 150 launched last year.
Texas Health Resources was among the first to form a Medicare ACO under the Center for Medicare and Medicaid Innovation's Pioneer ACO program. Long said Texas Health Resources and Blue Cross and Blue Shield of Texas drew on the Pioneer program as a model for their effort, but not without some changes.
Long said the Pioneer ACOs, which launched roughly one year ago, are at risk for penalties starting this year. “We think that's a little quick,” he said. The Blue Cross and Blue Shield of Texas and Texas Health Resources ACO will include potential bonuses but no risk for penalties, though the letter of intent does leave open the possibility of penalties in the future.
Long said as many as 200,000 patients could be included in the Blue Cross and Blue Shield of Texas ACO, which is a fraction of Texas Health Resources' patients “but the idea is to get started,” he said.