PHILADELPHIA, Oct. 2, 2013 (GLOBE NEWSWIRE) -- Keystone First, a Blue Cross Medical Assistance (Medicaid) product and the largest Medical Assistance product in Southeastern Pennsylvania, and Jefferson Health System (JHS) have announced a new multiyear shared savings agreement that ensures Keystone First Medical Assistance participants uninterrupted access to high quality, cost-effective care from JHS' physicians and facilities, including its health centers, six acute care hospitals and two rehabilitation hospitals in Philadelphia, Chester, Delaware and Montgomery counties.
JHS manages its new shared savings agreement under the auspices of the Accountable Care Organization of Pennsylvania, Inc. (ACO-PA). Under a shared savings agreement, providers receive a share of monetary savings resulting from appropriately managing care for a given patient population. This contracting approach encourages providers to deliver care that produces better health outcomes.
"Keystone First provides a critical health coverage safety net to the citizens of Southeastern Pennsylvania. JHS is pleased to share in that mission," said David F. Simon, executive vice president of Jefferson Health System and president of ACO-PA. "Our groundbreaking accountable care collaboration with Keystone First gives both organizations the data and tools to better monitor care and effect meaningful change for our patients."
At the heart of the new agreement is PerformPlus®, Keystone First's proprietary and innovative value-based incentive program that advances accountable care. Utilizing quality metrics and financial rewards for fulfilling certain benchmarks, PerformPlus fosters adherence to evidence-based clinical protocols and encourages more cost-effective care.
"By rewarding providers for better outcomes and efficiency, we help keep our members healthier and, as a result, out of the hospital and emergency room," said Russell Gianforcaro, executive director of Keystone First. "JHS serves tens of thousands of Keystone First members each year, and this collaboration will help Keystone First, JHS and ACO-PA provide more effective and efficient care."
Keystone First and JHS have agreed upon a series of quality metrics, which include:
- Potentially preventable hospital admissions;
- Potentially preventable hospital re-admissions;
- Low-acuity emergency department visits;
- Neonatal intensive care unit length of stays;
- Obstetric and primary care Healthcare Effectiveness and Data Information Set (HEDIS) measures; and
- Appropriate care measures – the percent of patients who received all recommended treatments based on their clinical condition.
- The metrics are based on 3M's "Potentially Preventable Readmission" logic, Ambulatory Care Sensitive Conditions, and HEDIS-based quality standards for prenatal, pregnancy and postpartum obstetric care.
JHS and ACO-PA will be able to track performance on the metrics using Keystone First's proprietary dashboard, a unique and innovative web-based portal that enables the shared savings partner to track their progress for each metric and produce self-service reports and drill-down data mining. The dashboard will also allow prompt identification of frequent emergency department utilizers, readmissions, HEDIS results, care gaps, clinical risk and other member-centric data to foster collaboration and meaningful member outreach.
"PerformPlus incorporates the key components of accountable care and effective health care delivery," said Jim Jones, vice president, Provider Partnership Innovations for Keystone First. "It represents a major shift from fragmented, volume-driven reimbursement to active and collaborative physician engagement as we pursue with JHS and ACO-PA our shared goal of better outcomes and health care value."
About Jefferson Health System
Headquartered in Radnor, Pennsylvania, Jefferson Health System members have more than 14,800 full-time employees, 2,435 beds and 3,400 medical staff members. Jefferson Health System includes Magee Rehabilitation Hospital; Thomas Jefferson University Hospitals, which includes the Jefferson Hospital for Neuroscience and Methodist Hospital; and Main Line Health, which includes Bryn Mawr Hospital, Paoli Hospital, Riddle Memorial Hospital, Lankenau Medical Center and Bryn Mawr Rehabilitation Hospital. In 2012, the Jefferson Health System was ranked as one of the Top 15 Health Systems in the nation by Thomson Reuters and Thomas Jefferson University Hospital was recently named to U.S. News & World Report's 2013-2014 Honor Roll of Best Hospitals. ACO-PA is an accountable care organization sponsored by Jefferson Health System. ACO-PA's objective is to align quality goals and payment models to incent the ACO-PA network of hospitals and physicians to deliver quality, value-driven care, with a high level of patient and provider satisfaction. For more information, about JHS and ACO-PA, visit our website at www. jeffersonhealth.org.
About Keystone First
Keystone First is a Medical Assistance (Medicaid) managed care health product offered by Vista Health Plan, Inc., a subsidiary of Independence Blue Cross. Keystone First has over 303,000 members in five Southeastern Pennsylvania counties. Here at Keystone First, we are mission-driven and dedicated to helping members get care, stay well and build healthy communities.
Independence Blue Cross and Vista Health Plan, Inc. are independent licensees of the Blue Cross and Blue Shield Association.