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Inland Healthcare Providers Seek to Cap Costs

"This is about making sure the healthcare system works as it should ... and people are receiving the right care at the right time," a spokeswoman for Blue Shield said.

Patients whose physicians belong to one of six Inland Empire medical groups that contract with Blue Shield of California can expect to see changes in their healthcare services in the coming months.

Blue Shield is partnering with Redlands-based healthcare consulting firm Epic Management LP to create an Accountable Care Organization that will focus on identifying ways to optimize outpatient treatment programs to rein in health maintenance organization, or HMO, costs, according to a joint statement released by Epic and Blue Shield.

"The goal is to improve quality and efficiency while bringing down healthcare costs," said Lindy Wagner, a spokeswoman for Blue Shield.

She told City News Service that 10 prior ACOs established in other parts of the state had proved valuable, and the hope is to realize the same value in the Inland Empire.

"This is about making sure the healthcare system works as it should ... and people are receiving the right care at the right time," Wagner said.

The physician groups whose 27,300 patients will be part of the ACO are Victorville-based Alliance Desert Physicians, Redlands-based Beaver Medical Group, Rancho Cucamonga-based Chaffey Medical Group, Rancho Cucamonga-based Pinnacle Medical Group, the Redlands-Yucaipa Medical Group and Temecula-based Tri Valley Medical Group.

According to Blue Shield, 7,000 beneficiaries are covered under the California Employees' Retirement System, or Calpers, while another 7,500 are covered under plans provided to employees of San Bernardino County government.

Wagner said ACO consultants will be examining a number of factors tied to patient outcomes to see where and what changes are appropriate.

"We don't know exactly yet what interventions will be necessary," she told CNS. "The consultants will be looking at detailed claims history to decide where they can impact change."

According to the Blue Cross spokeswoman, programs that other ACOs implemented to reduce healthcare costs included shifting patients to generic, as opposed to brand name, drugs, as well as improving transitional care, as when a patient goes from inpatient to outpatient status.

"There's more emphasis on follow-up to make sure people are not going back to the hospital," Wagner said. "The Accountable Care Organization aims to bring down re-admissions and help keep people out of the emergency room. That's one way to reduce the cost trend."

The Inland Empire ACO will be active for two years under terms authorized by the California Department of Managed Health Care.


—City News Service.

beaumontdave March 16, 2014 at 06:14 PM
Jeremiah, I'd be fine with a single-payer system, but had ACA included it, it never would have passed Congress.
Randall March 16, 2014 at 06:35 PM
Dave, so explain how it's better to have some bureaucrat sitting in DC deciding what care you will get than it is for you to decide based on the health plan you select. How is it fair, that you should have to pay for some other person's health care, when they didn't provide for it themselves? Doctors charge for their services. Why should you pay for me, if for example I wind up in the emergency room dying and I can't pay for my own treatment if I was the one who refused or couldn't pay for health insurance? Why should you subsidize anyone's care when you are only responsible to yourself for your own? Maybe, since progressives like to preach population reduction, the people that don't have the resources should just be left to die if they didn't make (1) taking care of themselves, or (2) purchasing healthcare coverage a priority. How much does a pack of smokes cost these days and how many welfare recipients are smoking a pack or two a day?
beaumontdave March 16, 2014 at 06:37 PM
Randall, if you are uninsured and have a stroke today, no emergency room can refuse you, all appropriate medical care must be administered, by law, and by risk of liability. That cost if unreimbursed by you, is absorbed by the hospital, and the reason 2 aspirin given might have a $25 charge, the price we all pay. It's not an option, like a car or anything else, we pay, now, today, yesterday, tomorrow. The bitch is you need follow-up care and physical therapy after your stroke to get back to normal, but only the county hospital will take you and maybe there's a four hour wait to find out you can't get PT appointments for four months, so you sit at home, losing your job and drawing disability[ which we all pay for], you sell your car, because you can't afford it, lose your house, find a cheap apt. in a lousy part of town, or move in with your mother. Finally in a year and a half your better, but your at square one and the road back to independence is high, steep, and hard. May you make it, may be you quit trying and become one more that everyone pays for.
Jeremiah March 16, 2014 at 07:42 PM
BD - you are completely right. A change to a single-payer non-profit system or anything else that minimizes the position of the Health Insurers will never ever be allowed. Remember who the investors in these Health Insurers are - taking the Health insurers out of the economic mix would crash the system irrevocably as those hedge funds and mutual funds and financial institutions lost the value of major parts of their holdings. **** Jeremiah
Jeremiah March 16, 2014 at 07:53 PM
Randall - what is the difference between a bureaucrat at the top deciding what is allowed for your health care and some health care plan manager deciding what is allowed for your health care? Either way it isn't your doctor deciding, is it? **** And all those things you say the government shouldn't do? Well, somehow they (or the financial interests behind them) don't agree with you and through the ACA and the insurance based system they are doing this right now. **** I hear your complaints, Randall, but I have one question - how do we go back from here? What would you propose as a fix that creates universal health care equally to all - remembering that not insuring homeless and unemployed costs you more in the long run than if you insure them? **** Jeremiah

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