Blue Shield of California, San Francisco, USA.
Health Aff (Millwood). 2012 Sep;31(9):1969-76. doi: 10.1377/hlthaff.2012.0358.
Health care plans and providers in the private sector are developing alternative payment and delivery models to reduce spending and improve health care quality. To respond to intense competition from other organizations, Blue Shield of California created a partnership with health care providers to use an annual global budget for total expected spending and to share risk and savings among partners for providing health care. The patient population consisted of certain members of the California Public Employees' Retirement System in Northern California. Launched in 2010, the pilot accountable care organization in Sacramento provided a framework for operations and established goals and financial risk arrangements. The model shows early promise for its ease of implementation and effectiveness in controlling costs. During the two-year period, the total compound annual growth rate for per member per month cost was approximately 3 percent, or less than half the rate at which premiums rose over the past decade. Some of the savings stemmed from declines in inpatient lengths-of-stay and thirty-day readmission rates. Results suggest that the approach can achieve considerable financial savings in as little as one year and can gain wide acceptance from reform-minded providers.
私营部门的医疗保健计划和提供商正在开发替代支付和交付模式，以降低成本并提高医疗保健质量。为了应对来自其他组织的激烈竞争，加利福尼亚蓝盾公司与医疗保健提供商建立了合作伙伴关系，使用年度全球预算来支付总预期支出，并在合作伙伴之间分担提供医疗保健的风险和节省的费用。患者人群由加利福尼亚州北部的加利福尼亚公共雇员退休系统的某些成员组成。萨克拉门托的试点责任制医疗组织于 2010 年启动，为运营提供了框架，并制定了目标和财务风险安排。该模式展示了其易于实施和控制成本的有效性的早期前景。在两年期间，每个成员每月成本的总复合年增长率约为 3%，不到过去十年中保费增长率的一半。一些节省来自住院时间和 30 天内再入院率的下降。结果表明，这种方法可以在短短一年内实现相当大的财务节省，并获得有改革意识的提供商的广泛接受。
