Banner Health Network to participate as Medicare Pioneer Accountable Care Organization
The Banner Health Network (BHN) announced that it has been selected to participate in the Pioneer Accountable Care Organization (ACO) model, a transformative new initiative sponsored by the Centers for Medicare and Medicaid Services (CMS) Innovation Center. Through the Pioneer ACO Model, BHN will work with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.
The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of doctors and other health care providers who work together to provide high quality care for their patients. As one in a diverse group of leading-edge health care organizations from around the country, BHN was chosen specifically by the Innovation Center to test the effectiveness of several models of payment in helping organizations make a rapid transition to higher quality care at a lower cost to Medicare.
“These Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coordinated care for patients at lower costs,” said Marilyn Tavenner, Acting Administrator of CMS. “The Banner Health Network has demonstrated significant experience in providing high quality, coordinated care and we are excited to partner with them,” Tavenner said.
In addition to participating in the Medicare Pioneer ACO, the BHN has recently partnered with Health Net to serve as the tailored network for their ExcelCare product, and Aetna to serve as their tailored network for their Whole Health product.
BHN has been designed to provide a highly coordinated patient care experience to Medicare members as well as members in ExcelCare, Whole Health and MediSun who will be served by this integrated network. BHN is comprised of Banner Health-affiliated physicians, 13 Banner hospitals (12 in the Phoenix metro area) and other Banner services in Arizona. Nonprofit Banner Health is Arizona’s largest health care provider. The network will ensure convenient access to Medicare members with more than 2,600 private and employed physicians located throughout Maricopa County and into Pinal County.
BHN is a comprehensive provider network that accepts patient care and financial accountability for those served by the network. It is one of a few networks in Arizona serving patients in a population health management model. This model offers a highly coordinated patient experience through a primary care setting that seeks to improve patient outcomes. It emphasizes wellness, including wellness at the highest level possible for patients suffering from chronic diseases. A key feature of this patient-centered model is the close collaboration among providers that will result in greater efficiency and improved control of costs. A foundation of the Banner Health Network’s ability to deliver collaborative, highly coordinated and integrated patient care is an enhanced electronic medical records system that is utilized in all Banner hospitals.
Under the Pioneer ACO Model, CMS will provide incentives for participating health care providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team.
“Through accountable care, the population health management model has real potential to emerge as a key element for controlling the rising costs of health care,” said Banner Health President and CEO Peter S. Fine. “Our deep involvement at this early stage of accountable care positions Banner Health and its BHN partners extremely well to thrive during this transformative phase of health care,” he added.
CMS will use robust quality measures and other criteria to reward ACOs for providing beneficiaries with a positive patient experience and better health outcomes, while also rewarding BHN for reducing growth in Medicare expenditures for the same patient population.
Robust quality measures and other criteria as reward incentives will also be applied to BHN’s partnerships with Health Net and Aetna, which will utilize the emerging population health management model. In these partnerships, reimbursement for services occur solely through monthly premiums paid by organizations and members enrolled for network medical care. There is no additional revenue beyond the premiums. As a result, network providers are incentivized to work in a highly collaborative, innovative manner to focus on wellness, coordinating care and providing services as efficiently as possible. This can result in costs for services being less than the premiums available within the network. These “shared savings” are then divided among the network providers as net revenue.
“This push toward higher quality and controllable costs through a highly coordinated patient care experience must move forward,” said Fine. “Our current system in this country isn’t sustainable,” he added.
The BHN is a patient care and financial accountability partnership between Arizona Integrated Physicians (AIP), a physician-owned organization, Banner Medical Group (BMG) and the Banner Physician Hospital Organization (BPHO). This partnership of more than 2,600 primary care and specialty physicians, along with Banner hospitals and other related health care services, will serve patients throughout Maricopa County and into Pinal County, a population base of more than 4 million people. Further provider member growth is anticipated as additional physicians and other professionals, particularly in the central valley, will be sought.
“We’re extremely pleased and proud to be part of the leading edge of an effort that I believe will transform health care delivery in America,” said AIP CEO Keith Dines. “In the not-too-distant future we envision BHN to be serving hundreds of thousands of members who will appreciate the enhanced level of care and service available through BHN.”