Blue Shield of California Invests $20 Million to Help Providers Develop Accountable Care Organizations

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Oct 17, 2011, 11:00 ET

Grants will help doctors and hospitals collaborate to optimize care

SAN FRANCISCO, Oct. 17, 2011 /PRNewswire-USNewswire/ -- A total of 18 California hospitals, health systems, clinics and physician groups – including many serving underserved populations – will receive grants totaling nearly $20 million from Blue Shield of California to help them participate more effectively in accountable care organizations (ACOs).

The ACO grants are being made as part of Blue Shield's 2 percent pledge, a commitment the company made last June to limit annual net income to 2 percent of revenue and to return the difference collected above that amount to customers and the community. Today's grants represent an average of $10 million for each of the two fiscal years (2010 and 2011) that the pledge has been applied.

ACOs are arrangements among providers and payors in which financial and clinical integration is created to foster greater efficiency and quality in the delivery of care to persons who access the ACO providers. Blue Shield currently participates in three ACOs in Sacramento and San Francisco covering 70,000 HMO members, and has plans for additional collaborations in Orange and Stanislaus counties aimed at delivering integrated, cost-efficient care to 38,000 members. ACO's are a key part of delivery system reforms included in the Affordable Care Act.

"We received nearly 60 grant applications from providers around the state. This demonstrates overwhelming interest among providers in collaborating to reduce costs and enhance the quality of care," said Paul Markovich, executive vice president and chief operating officer, Blue Shield of California. "Our grantees include a community clinic serving safety net populations, the largest independent Federally Qualified Health Center in the nation, several applicants seeking to better manage patients with chronic diseases like diabetes, and two children's hospitals."

AltaMed Health Services Corporation, which serves Latino, multi-ethnic and uninsured populations in Los Angeles and Orange Counties, will apply its $1 million grant to improve clinical integration with its Accountable Care Network hospital partners. "We thank Blue Shield of California for supporting our vision of improving access to care for the safety net population. This grant will greatly accelerate our ability to enhance continuity of care, manage post-discharge care of patients, and enhance coordination of care among the communities we serve," said Castulo de La Rocha, president and CEO, AltaMed Health Services Corporation.

The grantees, listed in order of grant amount, are as follows:


Applicant	Grant Amount	Region	ACO Project Description
The Greater Los Angeles Care Innovation Corridor	$300,000	Southern CA	Develop a seamless system of care and coverage that would lower annual costs of care, enable consistent delivery and transparent reporting around quality and safety, and implement an interoperable health information exchange.
Physicians Medical Group of Santa Cruz	$475,000	Greater Bay Area	Create a real-time care management tracking system that would help reduce bed days, emergency room visits and readmissions while increasing post-discharge follow-up, complex case management, care coordination and data sharing.
Greater Newport Physicians & Hoag Memorial Hospital Presbyterian	$643,610	Southern CA	Develop an ACO that would feature a Diabetes Medical Home intended to move 25% of diabetes patients to controlled status and deliver significant yearly cost savings.
Doctors Medical Center of Modesto	$650,000	Central CA	Deliver a post-acute discharge program that seeks to reduce post-discharge re-admissions and emergency room visits, improve primary care follow up, and reduce overall length of stay.
Share Our Selves (SOS), Comprehensive Care Solutions	$750,000	Southern CA	Implement the Integrated Continuum of Care Project to increase coordination with hospital partner and ultimately reduce length of stay, readmissions and emergency room use. Serves safety net population.
HealthCare Partners Affiliates Medical Group	$835,000	Southern CA	Develop interventions that improve coordination of hospital care and incentivize high-risk Medicare patients who suffer from chronic diseases such as diabetes to become more involved in their own care management.


Applicant	Grant Amount	Region	ACO Project Description
Chinese Community Health Care Association	$971,000	Greater Bay Area	Improve electronic laboratory ordering and reporting, develop care coordination initiative, and implement electronic health record system enhancements. Serves Asian and safety net populations.
Huntington Memorial Hospital	$980,000	Southern CA	Advance initiatives designed to decrease readmissions and emergency room use while promoting medical adherence.
Adventist Health	$1,000,000	Northern Central & Southern CA	Integrate physicians and three rural hospitals to reduce readmission and emergency room utilization and enable timely follow-up, referrals, care coordination and electronic prescriptions. Serves rural population.
AltaMed Health Services Corporation	$1,000,000	Southern CA	Implement a Health Information Exchange to share data and an evidence-based Medical Management and Care Transitions Model to help reduce avoidable admissions, length of stay, and service duplication for the patients of the largest independent Federally Qualified Health Center in the nation. Serves Latino and safety net populations.
Community Hospital of the Monterey Peninsula	$1,000,000	Greater Bay Area	Implement an ambulatory electronic health record for 150 physicians, adopt a community health information exchange for 100 physicians and 50,000 patients, and develop an information technology strategy to integrate clinical and claims data.


Applicant	Grant Amount	Region	ACO Project Description
Children's Hospital of Orange County	$1,040,000	Southern CA	Provide family-centered medical homes, case and disease management services, health educators, nutritional and social service advice and member services. Serves safety net and pediatric populations.
Facey Medical Foundation and Medical Group	$1,097,750	Southern CA	Establish an ACO including a medical home and care transitions model intended to reduce bed days, admissions, readmissions and emergency room use while increasing post-discharge provider visits, palliative care, home provider visits and hospice referrals.
Children's Hospital Los Angeles	$1,130,000	Southern CA	Expand pediatric medical home models and implement improved care coordination and case management, utilization management, quality improvement monitoring measures, an enhanced information technology platform linking providers, a more effective provider network, and the ability to accept and manage bundled payments. Serves pediatric population.
Brown & Toland	$1,700,000	Greater Bay Area	Create a local health information exchange to connect with other such exchanges locally and regionally and with other enterprise or stand-alone electronic health records, including small physician offices.
Hill Physicians Medical Group and Catholic Healthcare West	$1,800,000	Northern CA	Implement a tactical plan focused on high-risk patient analysis, avoidable day management, and emergency room management.


Applicant	Grant Amount	Region	ACO Project Description
St. John's Health Center	$2,000,000	Southern CA	Implement quality improvement program to achieve clinical integration among participating physicians, increase patient satisfaction, enable timely medical records, and increase use of generic drugs while decreasing readmissions and avoidable days.
St. Joseph Health System	$2,000,000	Southern CA	Implement the expansion of electronic health records, case management, utilization cost management, risk stratification and predictive modeling as well as to better manage outcomes and introduce preventative outreach services.
TOTAL GRANTS	$19,372,360*

* The remaining funds are set aside as a reserve for unexpected needs of the grantees and to monitor and evaluate implementation of the grants.

Selection Process

Blue Shield retained Putnam Community Investment Consulting, Inc. (Putnam) to administer the grant program. Putnam is a national consulting and evaluation firm that works with philanthropic foundations and nonprofit organizations to research, develop, manage and evaluate grantmaking strategies, programs and initiatives.

For Blue Shield's ACO grant program, Putnam managed the request for proposals by conducting broad outreach to potential applicants, organizing teleconferences for potential applicants to learn more about the funding opportunity, responding to applicant questions, developing proposal review criteria, and reviewing proposals. All funding decisions were made by a selection committee comprised of Putnam and senior Blue Shield executives directly involved in Blue Shield's ACO initiatives.

About Blue Shield of California

Blue Shield of California, an independent member of the Blue Cross Blue Shield Association, is a not-for-profit health plan with 3.3 million members, 4,800 employees, and one of the largest provider networks in California. Founded in 1939 and headquartered in San Francisco, Blue Shield of California offers a wide range of commercial and government products throughout the state. The company has contributed more than $125 million over the past four years to the Blue Shield of California Foundation—which was named one of BusinessWeek's 20 most generous corporate foundations. Contact your local agent or broker for more information about Blue Shield products and services, or visit the Blue Shield website at www.blueshieldca.com.

CONTACT:
Steve Shivinsky
Corporate Communications
(415) 229-5447
steve.shivinsky@blueshieldca.com

SOURCE Blue Shield of California