Advocate Health Care is Illinois’ largest health network, with roughly 6,000 affiliated primary care physicians, specialists and subspecialists. More than 4,500 of these physicians participate in Advocate Physician Partners (APP), a care management collaboration with Advocate Health Care that has garnered recognition for its clinical integration program.
Commercial and Medicare ACOs
In January 2011, Blue Cross Blue Shield of Illinois (BCBSIL) teamed up with Advocate Health Care to create the AdvocateCare ACO.
Through the AdvocateCare ACO arrangement, BCBSIL pays Advocate Health Care’s physicians and hospitals based on how well they meet quality, patient satisfaction and cost metrics for approximately 380,000 of the plan’s members. According to BCBSIL, from 2011 to 2012, the admission rate among approximately 200,000 members in the preferred provider organization (PPO) segment of the ACO decreased by 1.4%, whereas the rate increased by 2.2% at other hospitals in BCBSIL’s PPO network.
In July 2012, Advocate Health Care was selected to participate in the Medicare Shared Savings Program. It is the largest MSSP, covering 135,350 beneficiaries. In its most recent performance year, it lost about $39 per beneficiary, about 0.36% higher than benchmark.
Accountable Care Entities (ACE)
Illinois was required to transition at least half of its 3 million Medicaid beneficiaries into managed care by January 1, 2015, to reduce costs, and as part of that effort has given nine Chicago-area health care groups—including Advocate Accountable Care—preliminary approval to establish accountable care entities (ACEs), which are similar to accountable care organizations. The ACE model will replace the existing fee-for-service Medicaid payment model
The major rollout of the state’s ACE program was to be completed in July 2014 but delays occurred. Advocate’s chief medical officer, Dr. Lee Sacks, said his organization’s ACE, which could cover more than 150,000 Medicaid patients, would not happen until at least the September 1. No further updates have been available since.
According to Michael Randall, Advocate Physician Partners’ vice president for clinical innovation, Advocate manages approximately 550,000 Medicare and privately insured patients through its other coordinated care efforts. He noted that one of the state’s goals for the Advocate ACE is to strengthen its ties with community clinics.
In June, Advocate and UnitedHealthcare said they are are expanding their ACO agreement to include more than 80,000 UnitedHealthcare enrollees using an employer-based health plan. Last year they formed an ACO to manage 5,500 UnitedHealthcare lives under its Medicare Advantage plan. Mike Engelhart, president of Advocate Physician Partners, told Crain’s Chicago Business that he hoped the ACO would be as successful as the one Advocate launched with Blue Cross and Blue Shield of Illinois. UnitedHealthcare serves 1.4 million Illinois residents and Advocate, with 12 hospitals, is one of the largest systems in the state.
President and CEO, Advocate Health Care: James H. Skogsbergh
CEO, Advocate Physician Partners: Lee B. Sacks M.D.
V.P. for Clinical Innovation, Advocate Physician Partners: Michael J. Randall
President, Blue Cross Blue Shield of Illinois: Karen M. Atwood