Florida Blue Cross, the largest commercial payer in Florida, has
established an “Oncology ACO” that is one of the first specialty ACOs
in the U.S.
Florida Blue Cross Blue Shield
PROBLEM
2.9 million members in 2013
largest commercial payer in the U.S.
• Oncology accounted for 25% of total spend in 2012 with significant annual
increases
• Needed to find a way to control costs while maintaining quality
SOLUTION
17th
Developed accountable care contracts with two of their largest providers
of oncology care for six common cancer types (breast, female
reproductive, male reproductive, digestive, respiratory, lymphatic,
blood)
Baptist Health South Florida/Advanced
Medical Specialties (AMS)
•AMS has 46 oncologists in Miami that
admit to Baptist Health South Florida
•AMS is historically a high-cost practice
but recognized that a change needed to
happen
© 2014 Boston Healthcare Associates, Inc. | 1
Moffitt Cancer Center
•330 oncologists throughout Florida
•Historically provides more efficient
care, but room for improvement
•Physicians salaried
The Oncology ACO uses a “cancer year” to assess total cost of care;
shared savings are determined by cost savings and quality
measurement
The Cancer Year
•All fee-for-service costs for an individual patient
following diagnosis
•Excludes major trauma
Diagnosis
Baseline
Calculation
AMS
example:
•
Shared Savings
Calculation
Costs compared
against baseline to
determine shared
savings
One Year
Established
baseline ACO
membership in
that “year”
Established baseline
total cost of care for
the ACO membership
in that year
Established annual
cost of care per ACO
member in that year
355 patients
$27M
$96,000
Shared savings are determined by cost savings as well as adherence to quality metrics:
Physician Quality Metrics
Hospital Quality Metrics
•Chemotherapy regimen
compliance
•QOPI
•“End of life” metrics
•Participation in The Society of Thoracic Surgeons National Database
•Participation in a Florida, or national, surgical care quality initiative
•Perform at or above the Florida state average, for all reporting
hospitals, for multiple CMS measures
© 2014 Boston Healthcare Associates, Inc. | 2
While both institutions saw cost savings in the first year, Moffitt
excelled while the Baptist/AMS partnership had to initiate an entire
cultural overhaul
Baptist Health South Florida/Advanced Medical
Specialties (AMS)
• Experienced difficulty adapting to the
accountable care environment
• An overall culture change needed to be had in
both institutions (historically fee-for-service
and focused on chemotherapy margins to drive
revenue)
• Different IT systems between AMS/ Baptist
Health made care coordination difficult
• Small improvement in cost trend in the first
performance year of the program
Moffitt Cancer Center
•Structural necessities were in place to
achieve success
•All physicians are salaried, and there is
an ingrained culture of providing
efficient, quality care, making improved
care management an easier task
•Projected to be able to recognize 7figure savings in the first year of the
program (2013)
• Florida Blue is still trying to identify specifically where cost savings were derived, although they
do know that some cost savings came from reduced chemotherapy use
• Florida Blue recognizes that the easiest way to achieve savings is by reducing the quantity of
services rendered, but they are hoping to drive an overall culture change where physicians
understand their risk and financial responsibility while working to achieve the highest quality
care
© 2014 Boston Healthcare Associates, Inc. | 3