Blue Cross cuts deal with Sanford, Altru to pay by outcome
June 7, 2012 at 1:35 am in Grand Forks Herald
Blue Cross Blue Shield of North Dakota has signed contracts with two large health systems that will begin paying providers based on rewarding better patient outcomes. Continue Reading
Reads exactly like some of the provisions in the Affordable Care act to reduce costs (for those of us who read the entire thing). Hmmmmmm.
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Your right. It’s exactly the same framework as Obamacare, but, of course, Obamacare must be repealed and Sanford must be considered for a statewide award for coming up with a plan to reduce health care costs.
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You are absolutely correct, this is a page from the Obamacare playbook, but that is not the most interesting part of this story.
“Total Cost of Care.” This has been a mainstay of medicare for 20 years. DRG = diagnostic related groupings. If you are admitted with pneumonia, medicare pays “X” amount. If you get the patient out of the hospital before you use up all your $$, the hospital makes money. If you have complications or are slow to get better, the hospital eats the additional cost.
I wonder why it took so long for private insurance to adopt this model. The hospitals will not be happy. Do not look for the rapid expansion we have been seeing. DRG were implemented to close 10% of the hospitals nation wide (reduce redundancy) and it has easily met its goal.
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Their GOAL is to save HALF of ONE PERCENT?
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Well, it’s better than going up, right?
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If Altru doesn’t already they need to follow the example of their Mayo partner & put drs. on salary.
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Altru affiliated physicians are already on salary and have been since the Grand Forks Clinic days. They get base pay plus productivity bonuses. Pretty average stuff. Nothing radical.
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I thought Mayo’s system was unique.
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Not at all. It might of been at one time. Sanford’s pay scheme is very similar.
The biggest HMO is Kaiser in California. They own the doctors, hospitals, everything. They are an insurance company that provides everything in house to reduce cost. It is not a bad system. In fact, for day to day care they cannot be beat. If you get sick and need hospitalized, then things get a little dicier.
Kaiser really perfected the system. Many have followed. I do not know if Mayo came before Kaiser, or if they developed at roughly the same time. The biggest difference between Mayo, Altru, Sanford is that Kaiser is an insurance company where the other three are simply providers.
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