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Blue Cross, Lifespan and physicians group form ACO


Blue Cross & Blue Shield of Rhode Island’s headquarters, in downtown Providence.

Three  Rhode Island healthcare organizations, Blue Cross & Blue Shield of Rhode Island, Lifespan, a large hospital system, and Coastal Medical, a physicians group, have created an Accountable Care Organization to serve  45,000 patients.

The agreement aims to  improve how primary, specialty and inpatient care are delivered in the tiny but densely populated state.

The Providence Business News reports: “The pact offers incentives that reward enhanced care management and more efficient delivery of care for the 45,000 Blue Cross members who receive their primary care from Coastal Medical providers. The effort is expected to result in better health outcomes, lower costs and better service to patients, according to the deal participants.”

The paper said: “Blue Cross, Coastal and Lifespan will remain fully independent under this agreement, but each will work with the others in a more aligned fashion than ever before.”

Will retail clinics transform primary care?



A story in the Providence Business News investigates whether retail clinics  set up in drugstores by CVS and other pharmacy chains will transform primary care. That Rhode Island is also the headquarters of CVS adds a certain piquancy to the issue in the tiny state.

“It’s the latest iteration of easy-access care that’s forcing doctors, hospitals and insurers in Rhode Island and across the country to take notice, as they brace for federally mandated changes designed to stem the ever-rising costs of health care delivery,” noted the newspaper.

“The retail clinics are filling a market void, and they will continue to be relatively successful until the primary care physicians are able to fill that void,”  Augustine Manocchia,  M.D., chief medical officer of Blue Cross & Blue Shield of Rhode Island, told the paper.

Michael Fine, M.D., a former Rhode Island state health director, said  easy-access care  offered by CVS MinuteClinics and similar outlets, is cutting into primary-care physicians’ “bread and butter.”

“[Physicians’] economic survival depends on their ability to treat the sore throats and rashes. The more complicated conditions – they’re not well-paid for,” Dr. Fine told the publication. “The danger is that from a business-model perspective, we’re peeling away their margins.”

But Steven R. DeToy, director of government and public affairs at the Rhode Island Medical Society, says retail clinics could be a “great help” to providers if they stick with basic services .  But he’s wary that clinics might try to become something more. The paper said that “He says that could further fragment an already disjointed system of care.”

“I think hospitals are going to be the most challenged health care organization of the next 20 years,” Dr. Fine predicted to the paper. “If the rest of us are good at what we’re doing, hospital [visits] should drop by 40-50 percent and their volume will diminish. If it doesn’t diminish then we’re going to be a collaborative failure.” •

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