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Emory partners with Blue Cross Blue Shield

Over the past 15 months, Emory Healthcare has been working with clinicians—both Emory physicians and physicians in private practice—to build an infrastructure for a new clinically integrated network (CIN). The Emory CIN received its first major external endorsement this fall, when EHC signed a contract with Blue Cross Blue Shield of Georgia to provide care to BCBS-covered patients. The contract is EHC's first foray into an arrangement with direct accountability for the value of care as assessed by defined quality metrics and overall cost.

"This was a major milestone for us," says Patrick Hammond, chief market services officer for EHC and executive director of the CIN. "BCBS is the largest payer in the state, and we are the first organization in Georgia they have partnered with and one of the first that WellPoint [Georgia's BCBS carrier] has partnered with nationally." He adds that the contract reflects BCBS's interest in enhancing value for its members and its confidence that the Emory CIN is positioned to do this.

What is a CIN, and why is it needed?

A CIN is a network of physicians and hospitals formed to improve care coordination among its members to improve quality outcomes and manage costs more efficiently.

"We have achieved great innovations in health care in this country, but everyone recognizes that the cost curve is unsustainable," says Rick Gitomer, CIN president, chief quality officer, and director of medical services. "Our CIN will help us bend the cost curve downward while we continue to improve overall quality of care and thereby increase value."

"The CIN will help us integrate care among network members and apply the same quality principles throughout the network that have recently earned two of our hospitals top 10 rankings in the University HealthSystem Consortium Quality & Accountability Scorecard," adds Bill Bornstein, vice-chair of the CIN board and EHC chief quality and medical officer. "It expands our referral base in the region and aligns quality incentives with financial ones."

Patrick Hammond Rick Gitomer Bill Bornstein

Patrick Hammond


Rick Gitomer


Bill Bornstein

The Emory CIN currently includes Emory-owned and jointly owned hospitals, Southern Regional Medical Center, and some 2,250 physicians either employed by Emory or in private practice.

Gitomer explains that the EHC CIN will support providers' gradual transition from episodic, fee-for-service care to patient-centered management of populations, with increased focus on care coordination, prevention, and proactive versus reactive care. Patients who stay healthier and whose conditions remain stable are not only better off, but they also consume fewer expensive health care resources. The CIN provides a means for EHC to recoup savings in unspent resources to invest in tools to further enhance value as well as support Emory's missions in care, teaching, and research.

The CIN will rely on electronic connections to integrate care throughout the network. All CIN members are required to implement an electronic medical record (EMR) if they don't have one already, and the various EMRs will be linked to EHC's new health information exchange, which will allow all CIN EMRs to exchange the clinical information needed to coordinate care and facilitate collection of quality data to support continuous improvement activities.

"The fact that our Office of Quality has been involved in leading the CIN from the beginning is crucial to its success," says John Fox, EHC president and CEO. "These are the people who are helping envision how this model will work not just locally but for the nation as a whole. Emory Healthcare intends to lead the way forward in the Atlanta market and nationally by building this integrated network to provide geographic coverage throughout the region as a platform for increasing value and reducing the rate of growth in cost."

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