health services

Blue Cross, Care New England move toward new contract

BLUE CROSS Blue Shield of Rhode Island headquarters.
Posted 8/9/12

PROVIDENCE – Blue Cross & Blue Shield of Rhode Island and Care New England have signed a letter of intent to reopen their current contract and create a new, five-year “partnership” that repositions reimbursements according to new global payment and quality metrics, the health insurer and the hospital system announced Thursday.

The new partnership grew out of ongoing informal talks between Peter Andruszkiewicz, president and CEO of Blue Cross, and Dennis D. Keefe, president and CEO of Care New England, who both assumed their new leadership roles in 2011.

The new contract will define specific metrics based on quality-related programs, including creation of a more patient-centered model for both maternity care and for behavioral health, according to Andruszkiewicz.

“We have mutual interests with Care New England in addressing and treating behavioral health issues in a new fashion,” Andruszkiewicz said. In behavioral health, he continued, “there are tremendously high costs, and high levels of inpatient and outpatient utilization; it’s a very fragmented system.”

Under the new contract, the hospital and the insurer will structure payments that reward better coordination, integration and alignment of behavioral health resources with primary care pharmacy care, with the goal to improve outcomes and reduce costs, according to Andruszkiewicz. “We want to create incentives to better coordinate care and management of these patients, rather than keep them in silos,” he said.

“The market waits for no one,” said Keefe, repeating a phrase that he said he often has used during the first year as the leader at Care New England. “We wanted to step out and be bold and innovative and bring this together in a concrete partnership.”

The big story here, Keefe continued, “is the idea that a health insurer and a hospital system and physician groups can work together as partners, with everyone rowing in the same direction.”

Instead of a contentious adversarial relationship between an insurer and a health care entity, Keefe said the new partnership will work toward “fundamentally moving away from fee-for-service, and move toward population health, global payments and capitation.”

Andruszkiewicz told Providence Business News that many of the precise details are still being worked out in negotiations. He said he expected that the new contract will be in place by the end of September.

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