Florida Blue Launches Oncology ACO

Margaret Dick Tocknell, for HealthLeaders Media , May 14, 2012

Florida's major health insurer has joined forces with two South Florida healthcare providers to create a specialty accountable care organization that will focus on oncology services.

Florida Blue, Baptist Health South Florida, and Advanced Medical Specialties (AMS), a Miami-based oncology group, are partners in the collaboration.

There are an estimated 160 ACOs or ACO-like organizations at some stage of development across the country, according to a November 2011 study by Leavitt Partners, a Salt Lake City, UT–based health intelligence business. Commercial ACOs are typically focused on population health issues such as reducing hospital readmissions and reducing emergency room use.

But dedicating an ACO is a specific specialty such as oncology is relatively new, and the Florida organization is believed to be among the first in the country.

Florida Blue and AMS, which has 46 physicians in 17 locations throughout the Miami-Dade County area, have worked together on other quality protocols. The physicians admit to Baptist Health, which is part of the Florida Blue network, so the three decided to look at working together on an ACO.

The collaboration is the first specialty ACO for the large insurer, which also hopes to develop a cardiology ACO and expand its specialty ACO model statewide to promote integration of healthcare. Oncology was selected for the kick-off because is "a major specialty cost driver in the state," explains Jon Gavras, MD, chief medical officer and senior vice president-delivery system for Florida Blue.

ACOs are attractive to oncologists, who are seeing their revenue streams disrupted as payers, especially Medicare, reduce reimbursements for cancer drugs. The coordinated care approach provides an opportunity to reduce the cost of cancer care by sharing in efficiencies in the treatment process.

The Florida Blue ACO model will focus on patients who need interventional services or modalities of treatment, which tend to be intensive, expensive and involve substantial hospital costs.

Garvas says a disease such as diabetes will not be pulled into the ACO model because in the early stages of the disease treatment it is physician-, not hospital-based. He says good primary care that is managing the risk factors around diabetes, including closely monitoring blood sugars, leads to better outcomes. Garvas explains that the disease is already being aggressively managed through Florida Blue's patient-centered medical homes.

The oncology ACO with Baptist Health and AMS began on May 1 and Gavras says there is no distinct time period for the collaboration. "We're looking for an evolution of the program to enlarge in size and expand to other specialties."

In the beginning, an estimated 500 to 1,000 of Blue Florida's commercial members are expected to be part of the ACO. There are plans to expand the program to its Medicare Advantage members in South Florida.

The ACO will look at clinical outcomes tied to readmission rates, adherence to chemotherapy regimens, and adherence to accepted clinical guidelines as well as the efficiency of care delivered to the patient.

Garvas declined to discuss the financial arrangements for the ACO but said the upfront costs include analytics. "This is a data intensive process. The amount of data and information that has to be pulled together and gone through is enormous. This is not easy stuff." Florida Blue will provide much of the data analysis. AMS will maintain the electronic medical records.