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UnitedHealthcare, Banner Health Collaborate

Banner Health Network and UnitedHealthcare are launching an accountable care organization (ACO) initiative to provide improved care coordination and enhanced health services to nearly 50,000 UnitedHealthcare plan participants in the region.

Banner Health Network’s (BHN) partnership with UnitedHealthcare will help shift Arizona’s health care system from one based on volume of care to one that rewards quality and value. Banner Health Network and its affiliated physicians will manage all aspects of patients’ care, providing the right care in the right place at the right time. Primary care physicians in the ACO will receive regular patient updates, enabling them to monitor all of the care each patient is receiving, and to maintain all clinical information about each patient in a secure patient registry.

UnitedHealthcare employer-sponsored plan participants who are currently served by BHN’s care providers will not have to do anything differently to receive the benefits of this new model, which include enhanced care coordination and follow-up.

BHN includes 3,000 care providers and 15 hospitals. BHN was one of the first care provider networks in Arizona to adopt the principles of accountable care, and one of the original 32 organizations nationally selected by the Centers of Medicare & Medicaid Services (CMS) to demonstrate the Medicare Pioneer Accountable Care Model. BHN was one of the top performers among this select group in terms of achieved savings in the first year. Using the same technology, clinical models and engaged care providers, BHN has been able to adapt these value-based learnings to better serve people enrolled in commercial health plans, such as those of UnitedHealthcare.

“Banner Health Network is pleased to work with UnitedHealthcare to deliver value-based health care options for Arizona employers and their employees,” said Chuck Lehn, CEO, Banner Health Network. “We anticipate Banner Health Network’s 3,000 care providers will manage the care of more than 300,000 people who are enrolled in a variety of risk-based health plans. We use evidence-based guidelines to close gaps in care across our population. Yet, we also do not forget that each of our patients is unique and needs individual support to meet personal health goals.”

UnitedHealthcare and Banner Health Network will coordinate evidence-based care, ensuring that the primary care physicians, specialists and facilities are aligned with the Institute for Healthcare Improvement’s (IHI’s) “Triple Aim” objective: increase patient satisfaction, improve the health of the population and reduce the cost of health care.

Care providers will be eligible for payment incentives based on meaningful improvements in measures such as hospital readmission rates, disease management and prevention, patient safety and care delivery, as well as total cost savings and patient satisfaction.

“UnitedHealthcare continues to work with care providers statewide to help enhance health services and improve coordination of care for patients,” said Beth Soberg, president and CEO, UnitedHealthcare of Arizona. “We believe our accountable care collaboration with Banner Health Network will deliver enhanced quality, better outcomes and greater efficiency for our health plan customers in Arizona.”

This new ACO relationship is the latest in a series of partnerships UnitedHealthcare has launched in Arizona, all aimed at increasing quality and coordinated care. UnitedHealthcare recently announced similar arrangements with two other care provider networks in the Tucson and Phoenix areas.

Nationwide, more than $30 billion of UnitedHealthcare’s annual physician and hospital reimbursements are tied to accountable care programs, centers of excellence and performance-based programs. The company projects this will reach $65 billion by 2018. For more information about UnitedHealthcare’s accountable care initiatives, visit www.AccountableCareAnswers.com.

UnitedHealthcare serves 1.6 million people in Arizona with a care provider network of 78 hospitals and more than 14,000 physicians statewide.

Banner Good Samaritan Hospital

Innovative Banner program helps cut healthcare costs

In its first year of performance, Banner Health Network (BHN) was successful in delivering more coordinated care and a considerable savings over traditional fee-for-service Medicare plans as part of the Medicare Pioneer Accountable Care Organization (ACO). BHN leaders are now focusing efforts on the true test of this model– whether it can be sustained and improved upon in coming years.

“We are very pleased by our first year results in Medicare’s Pioneer Accountable Care Organization,” said Tricia Nguyen, Chief Medical Officer for Banner Health Network. “Our ability to deliver shared savings, in excess of $13 million, has been the result of more coordinated care by our providers, advanced population health technology and surrounding our most vulnerable and chronically ill beneficiaries with supportive case management.”

In the first year BHN also demonstrated an ability to reduce hospital admissions, hospital length of stay and the need for hospital readmissions by supporting beneficiaries when they are most at risk and in need of care and advocacy. BHN was a top performer in terms of shared savings compared to other Pioneer organizations nationally.

“Through our experience, we believe the value-based Pioneer ACO model has merit, and that it has the potential to diminish the predominance of fee-for-service plans in government and private sectors,” said Chuck Lehn, CEO for Banner Health Network. “It is the best solution at this time for creating sustainability for the Medicare program, and could be the basis for historic change in the U.S. healthcare industry.”

Banner Health Network will proceed with the Pioneer ACO program in Performance Year 2 (calendar year 2013) and has begun recruiting additional physicians for Performance Year 3 (calendar year 2014).

The Centers for Medicare and Medicaid Innovation (CMMI), that operates the Pioneer program, reported that the results from the Pioneers overall were promising. “These results show that Pioneer ACOs have been successful in reducing costs for Medicare, improving the quality of care for their patients, and that incentives to align payment with quality can work.”

In December 2011, Banner Health Network announced that it had been selected as one of only 32 organizations in the country to demonstrate the Pioneer ACO Model.  The central premise of the Pioneer ACO effort is to create value through a highly coordinated, collaborative network of providers who are focused on achieving the highest level of wellness possible for their Medicare patients.

The financial incentive for Pioneer physician providers is to have improved financial benefit through shared savings, not increased volume of services that are reimbursed in a traditional fee-for-service model. Provider revenues are generated through a percentage of Medicare savings. Further, if provider expenses are greater than available Medicare funding, the individual ACO is at risk for that loss.

In addition to participating in the Medicare Pioneer ACO, BHN has developed accountable care relationships with Blue Cross Blue Shield of Arizona, Aetna, Health Net, United Healthcare and Cigna in the last 18 months.

BHN is comprised of Banner Health employed physicians and Banner affiliated physicians; 13 Banner hospitals (12 in the Phoenix metro area); Banner Health Centers and Clinics; and other Banner services in Arizona. The Network ensures convenient access to Medicare members with more than 2,600 physicians located throughout Maricopa County and into Pinal County.