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Blue Cross Blue Shield and Caritas Christi Hospital System Sign Five Year Contract To Include Global Payment System – Hospitals

Posted Nov 29 2009 10:01pm

Caritas has been doing a lot of work recently getting things in order with their financial recovery and restructuring.  Not too long ago they signed with image Microsoft to install Amalga in their hospital system. 

Caritas Christi Health Partners with Microsoft Amalga

Also, Caritas Christi is also part of the Innovative Learning Network, along with Kaiser, Partners, the VA and more.  This is pretty much the first step to go beyond fee for service with health insurance carriers.  This will probably mean more business intelligence software, more utilization scrutinizing to ensure that Caritas does not end up biting the bullet and instead make a profit.  This is a bit of a gamble as this contract is one of the largest for Blue Cross in the state and they are looking to add more contracts of such. 

The Innovation Learning Network – Major Healthcare Organizations Working Together with “Design Thinking”

image

As mentioned below, going out of network is going to be more than costly said the CEO of Tufts, and could stand to cause failure  This almost sounds like the rejuvenation of the HMO concept with a few minor changes/provisions.  It appears that we are all going to live and die by the contracts and not necessarily the doctors we may want or need to see at the advice of a primary care MD, in other words the doctor in network appears to have financial priority here and out of network will be scrutinized when proven too costly.  BD 

Health insurance carrier Blue Cross and Blue Shield of Massachusetts and Boston’s Caritas Christi Health Care, a chain of six community hospitals in eastern Massachusetts, yesterday said they have signed a new five-year “alternative quality contract.’’

The contract includes a so-called global payment system in which hospitals will be paid fixed amounts based on the estimated annual costs of patients’ care instead of the fee-for-service system in which providers bill insurers for individual visits and procedures. It also includes incentives to improve the quality and affordability of care.

If Caritas can keep health-care costs under a certain budget, it can make a profit. But if health-care costs go over the agreed-on amount, Caritas is on the hook.

The deal with Caritas is one of the biggest for Blue Cross, which started signing similar agreements this year with other hospital systems and physicians in the state. Now, more than 20% of its provider network has signed on to this type of payment system, which it calls the "alternative quality contract."

Patients must "understand that if they want cost control, then going in and out of network will cause the system to fail," said Ellen Zane, the chief executive of Tufts Medical Center in Boston.

Blue Cross Blue Shield, Caritas Christi in pact - The Boston Globe

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