The doctors who work at University of Kansas Health System, North Kansas City Hospital and Shawnee Mission Health are usually competitors. But they’re joining forces in a new type of health plan that could make them all wealthier — if they can keep you healthier.
About 1,600 physicians from those three health systems and the independent Kansas City Metropolitan Physician Association announced this week they have formed a clinical integration network called Centrus Health Kansas City. They also announced that the network has an agreement with Blue Cross and Blue Shield of Kansas City, and has applied for one with Medicare, to form Accountable Care Organizations that tie payments to patient outcomes.
“It’s a really unique opportunity for this sort of delivery model to come to Kansas City,” said Jill Watson, executive director of Centrus Health Kansas City. “We know the city is asking for it and we’re pretty excited about the partners we put together and the direction of the physician leadership that’s involved.”
Watson, the CEO of the metropolitan physician association, said about 90,000 patients who are on Medicare and Blue KC employer-based insurance will be part of the network if the Medicare application goes through. If the participating physicians can show that they created savings by coordinating care, they will get a portion of those savings distributed back to them.
According to Medicare data, Centrus Health isn’t the first such agreement in Kansas City, but it would be the first to cross multiple hospital systems.
Watson said the Centrus Health physicians have agreed to share patient data in a central hub where it will be used to identify physician groups that perform well on dozens of health metrics, like preventing unplanned hospitalizations for patients with diabetes, heart disease or other chronic conditions and getting patients their vaccinations and screenings at the recommended age.
“Take colorectal (cancer) screenings, for example,” Watson said. “They pull together what is the rate at which practitioners are able to get their patients’ colorectal screenings at the right time. Some of them are very good and some are not so good.”
The data will be shared so the doctors that score well can share methods with those who do poorly and, ostensibly, bring the whole network up.
April Schweitzer, a Chicago attorney who specializes in helping form clinical integration networks and ACOs, said they’ve been cropping up across the nation since the 2010 passage of the Affordable Care Act, commonly called Obamacare.
The law provided incentives within Medicare to coordinate care among primary care doctors, surgeons, hospitals and other providers to avoid duplicate or unnecessary tests and procedures.
The idea was to move to a medical model that rewards providers that keep people healthy, not just treat them when they’re sick.
A smaller but similar arrangement between physicians at three health systems in Minneapolis and St. Paul resulted in an 11 percent reduction in cost of care and better outcomes for people with five high-cost conditions in five areas (cardiology, endocrinology, gastroenterology, orthopedics and mental health/substance abuse).
Schweitzer said Centrus Health Kansas City is comparable in size to other such physician networks starting up in other parts of the country, and having a large commercial insurer like Blue KC already on-board is a good sign. But there’s no guarantee Centrus Health will be able to deliver on the improved health outcomes and reduced costs.
“It’s hard to tell,” Schweitzer said. “You have to see it get up and running and you have to see if the data is really working between the providers. But that’s the idea: better care that’s rewarded for quality rather than just fee-for-service.”