Within the half year, a large employer and three hospital systems in the Seattle area are launching an unusual accountable care experiment that removes the insurance company middleman. The arrangement is also notable because it will use practically every tactic under way in managed care: health savings accounts, value-based benefits, narrow networks and medical homes. The experiment involving large aerospace manufacturer Boeing Corp. will be closely watched not only for the ACO portion, but also for its everything-but-the-kitchen sink approach to making employees healthier while slowing down the costs of doing so.
The ACO will operate under the name of Preferred Partnership and is being offered to some 27,000 active employees and another 3,000 retirees in the Puget Sound area. While employers have been at the forefront of the accountable care movement for several years, this is one of the first times a major employer has gone directly to large hospital systems in this case University of Washington Medicine and Providence-Swedish Health Alliance to fashion an ACO without the likes of Aetna, Cigna or a Blue Cross and Blue Shield plan.
While health plans have been busy forging ACO agreements with provider systems on behalf of their large self-insured clients, the Boeing deal could be a game-changer in the movement away from fee for service-based care. If Boeing, or any other self-insured employer, provides the benefit design, the funding and other administrative functions while the hospitals and physicians provide the patient care and accept responsibility for outcomes, you've got an ACO without the need for an MCO.
Boeing's recent announcement got a lot of attention in the Pacific Northwest, but it remains to be seen whether employees will actually choose to join Preferred Partnership. The company will continue to offer its PPO, but it will definitely sweeten the pot for employees who embrace the new plan. Among the enticements:
- Health savings accounts: These benefit designs include a high deductible and a tax-advantaged savings account, which in this case Boeing will contribute toward.
- Value-based benefit designs: Those who see primary-care-physicians in the ACO, many of whom operate in medical homes, will have lower office copays. Employee and patient incentives are increasingly popular in commercial ACOs to keep patients tightly aligned to the best-performing physicians. In addition, generic drugs may be covered without cost-sharing for ACO-aligned employees.
- Easier network access: ACO members would receive faster access to PCPs and specialists and more after-hours availability. The physicians attached to the ACO are likely to represent a narrow slice of the total physicians affiliated with Providence, Swedish and the University of Washington.
Much of what Boeing wants to do with its ACO makes total sense, and has been under way more than a year in New Mexico in a similar arrangement between Intel Corp. and Presbyterian Health (one key difference being that Presbyterian also operates a health plan).
ACOs are all about providing incentives to providers to deliver timely, top-quality and efficient care. Commercial ACOs are now offering similar incentives to employees and patients. It is way past time when patients got more involved in their own care. The question is whether they and their employers will take health plans along for the ride, or not.
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