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RGHS, Excellus BCBS and GRIPA Reach Groundbreaking Payer Agreement

June 14, 2013

Visionary Health Care Model Rewards Physicians for Improving Quality, Safety and Efficiency of Care

Rochester General Health System (RGHS), Excellus BlueCross BlueShield and the Greater Rochester Independent Practice Association (GRIPA) have finalized a health care delivery and reimbursement agreement designed to curb costs, increase transparency and accountability, and improve patient care and the overall health of the community.  The agreement is part of a new, comprehensive Care for Health Accountable Care Partnership initiative between RGHS and GRIPA.

The landmark five-year agreement  will help the industry move from the current “fee for service” health care payment system that compensates based on quantity of care to one that truly rewards outstanding clinical performance, promotion of health and wellness, and greater efficiency − all with the central goal of improving the health of the Greater Rochester area.

“Our emerging Care for Health accountable care payment and delivery system will serve as a regional and national model as communities nationwide prepare for health care reform,” said Mark Clement, president and CEO of RGHS. “Our goal with this initiative is to develop a truly integrated and accountable delivery system where every key stakeholder in the process is focused on keeping our patients’ long-term health a top priority.” This payer agreement with Excellus BCBS serves as an important foundational element from which to build this patient-centered system of the future.

RGHS, Excellus BCBS and GRIPA-member physicians work together as partners in this innovative approach to manage the health of nearly 110,000 patients in the area. Leveraging developments in electronic medical records and care management support to improve care coordination, the partnership will enable patients to benefit from better, more proactive care by providers and the Health System. All physicians affiliated with GRIPA and RGHS are poised to receive this additional support, while being financially rewarded to keep patients healthy – versus being compensated solely for performing tests and procedures. 

Fee-for-service has been the health care industry standard, and is facing significant change in light of the Affordable Care Act. "Rising health care costs impact everyone and that's why we've developed with our partners an innovative provider payment arrangement that will help to reduce these costs while at the same time improving the quality of care a patient receives," said Christopher Booth, CEO of Excellus BCBS.  "Supporting providers in their efforts to take charge of managing their patients and ensuring they receive routine and preventive care helps to improve health and reduce the risk of more serious and costly care.”

Also leading this agreement are local physicians, dedicated to ensuring patients receive even better care through proactive care management. “In the new era of health care, it is critical to provide the right support to primary care physicians to enable them to succeed in filling their central role of active patient health oversight,” said Dr. Joseph Vasile, president and CEO of GRIPA. “GRIPA’s care management approach provides comprehensive, collaborative support to primary care providers, and has demonstrated proven results to improve the health of the patients we serve.”  GRIPA uses an advanced data repository and Information Technology system to identify and target high-risk patients in need of extra care, and then works closely with primary care physicians and their patients to help them get on a healthier path.

With care management, patients receive hands-on support to lead healthier lifestyles, both for their benefit and now for the additional benefit of reducing medical costs. Care managers assist patients in areas such as medication compliance and lowering prescription drug costs, and navigating the complex health system to ensure better coordinated care and attention. 

Rochester leaders have already seen the accountable care model succeed. Dr. Cynthia Reddeck-LiDestri is a former cardiologist who gave up her practice to run the health and wellness program for LiDestri Foods, a local company that uses GRIPA care management. “The care managers from GRIPA have helped many of our employees take a more active role in their wellness,” she explained. “People can significantly improve their lives with this approach to health care.”