FACT SHEET: Blue Shield of California and Accountable Care Organizations (ACOs)

2010 Results: By sharing data, the three organizations have been able to identify where costs are unduly high and implement solutions to bring those costs down.

Overutilization: Hysterectomies and elective knee surgeries were revealed to be the biggest cost drivers in the region among CalPERS members. Hill Physicians and Dignity are collaborating on alternatives, including evidence-based approaches to therapy and treatments that should be pursued before recommending surgery. 

Preventable Readmissions: Through data analysis, the participants are able to more efficiently identify the causes of preventable readmissions. When patterns of readmissions are discovered, processes are changed to improve case management and discharge planning, plus caregivers are educated on ways to address issues that are causing the readmissions. 

Final outcomes from calendar year 2010 include: 

  • 15% reduction in inpatient readmissions 
  • 15% decrease in inpatient days 
  • 50% decrease in inpatient stays of 20 or more days 
  • A half-day reduction in average patient length of stay 
  • $15.5 million saved

2010-11 Results: The collaboration delivered $37 million in savings to CalPERS based on the pilot trend versus non-pilot trend. The parties beat the 2011 cost-of-healthcare target by $8 million, which was shared by the parties. 

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