OneHealth Nebraska signs ACO contract with BCBSNE

OneHealth Nebraska announces the signing of its Accountable Care Organization contract with Blue Cross Blue Shield of Nebraska (BCBSNE). Fifteen primary care clinics in Lincoln will be part of the contract including more than 100 family physicians, internists, pediatricians and OB/GYNs caring for 30,000 BCBS patients.

Accountable Care Organizations (ACOs) are a new innovative model of healthcare where physicians are rewarded for improving the health of their patients, improving patient satisfaction and preventing avoidable health complications. This approach is a win-win for patients, healthcare providers and employers. 
 
According to Dr. Bob Rauner, Chief Medical Officer of OneHealth Nebraska, “unlike past HMO contracts in the 1990’s or current narrow network approaches, we will avoid exclusive contracts that don’t allow us to send our patients to the best source of care when they need it. We want to be able to send our patients to the same places we would send our mom or our kids.”

“With this agreement  we hope to increase the quality of care and improve our member’s experience and lower their costs,” Dr. Joann Schaefer, BCBSNE executive vice president said.  “Coordinated care is like building a scaffolding around a patient.  We know the closer a patient is to a doctor the better the care they get and the quicker early stages of disease can be discovered and treated.”
The clinics will be implementing a systematic quality improvement program to improve the quality of care provided to their patients. The ACO as a whole will be publicly reporting their results next year so Lincoln residents can make an informed choice for their source of healthcare. 
 
Many of the fifteen clinics have already been working on these types of quality improvement efforts.  Says Dr. April Brinkhoff of Fallbrook Family Health Center, whose clinic has been working to improve their screening rates for breast and colon cancer screening as part of the Nebraska Physician’s Cancer Screening Initiative, “what really makes me excited about the ACO concept is the transparency that will allow patients to see the quality of care they are getting.  At Fallbrook Family Health Center, we strive to give our patients the best possible care, but now we will be able to share the objective information with everyone.”
 
Says Dr. Phil Boucher, lead physician for Lincoln Pediatric Group whose clinic is one of the four OneHealth Nebraska pediatric clinics working on a community initiative to improve HPV vaccination rates in Lincoln, "it's a great opportunity for us as pediatricians to provide evidence-based care, learn how we can save our patient's money, and work as a group to improve the quality and consistency of care. Just discussing our HPV initiative caused an improvement in our numbers before even launching the project!"

As part of the BCBSNE contract, and because many patients are struggling with high out of pocket expenses and deductibles, the clinics will also be working with patients to lower their healthcare costs. For example, the cost of a common MRI scan of the back can vary in cost by thousands of dollars. Says OneHealth Nebraska CEO Steve Kros, “by showing patients the costs of healthcare services, we can help them pick a high quality imaging center such as Advanced Medical Imaging where a high quality scan can be done for a cost that is 40-60% lower than competitors.  We can help patients do the same for other common elective procedures such as colonoscopies or knee surgeries.”
 

1. Capital City Pediatrics (7441 O Street, Suite 303)

2. Children First Pediatrics (4230 Pioneer Woods Drive)

3. Coddington Medical Family Practice (1336 West A Street)

4. Doctors of Children (6041 Village Drive, Suite 150)

5. East Lincoln Family Health Professionals (4545 South 86th Street)

6. Fallbrook Family Health Center (755 Fallbrook Boulevard, Suite 100)

7. Family Health and Wellness Center (6825 South 27th Street, Suite 201)

8. Family Physicians Group PC (770 North Cotner, Suite 205)

9. Gynecology & Fertility PC (1500 South 48th Street, Suite 508)

10. Lincoln Family Medicine Center (4600 Valley Road, Suite 200)

11. Lincoln Internal Medicine Associates (3901 Pine Lake Road, Suite 220)

12. Lincoln Pediatric Group (4501 South 70th Street, Suite 110)

13. Nebraska Internal Medicine PC (770 North Cotner, Suite 220)

14. People’s Health Center (3 locations - 1021 North 27th Street, 2301 O Street and 2222 South 16th Street, Suite 435)

15.Primary Care Partners (2 locations – 3201 Pioneers Boulevard, Suite 304 and 4130 Pioneer Woods Drive, Suite 2)

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COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

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SUBSTANCE ABUSE DISORDER SERVICES

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out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

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specialist

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