Headshot photo of Paul Eisenstat

ACQAs and the Quest for Quality, Affordable Health Care

Finding common sense in a time of chaos

Value-based care. Accountable Care Organizations (or ACOs). Value-based payments. If you’re involved with health care, you’re probably familiar with these terms. They’re part of the nationwide shift toward a provider compensation model focused on efficiency and quality of outcomes as opposed to quantity of services.

While this concept is commonplace now, it was a different story back when a few Excellus BlueCross BlueShield colleagues and I developed our own version, called Accountable Cost and Quality Agreements (ACQAs, pronounced aquas).

As my colleagues and I contemplated the uncertainty of the times, we asked ourselves, “There has to be a better way, right?”

A perfect storm for change

It was the early 2010s. The Affordable Care Act (ACA) had just been passed. It was chaotic. No one knew what was going on or what the ACA would mean. Would health plans as we knew them even continue to exist? What would our role be? Why was the song Gangnam Style so popular? People were confused and frustrated across the board.

As a result of the new health care mandate, ACOs began to pop up. These early endeavors were great in theory but didn’t garner much support from the public or the industry. Partially due to people’s intrinsic resistance to change, and also because the expectations of ACOs and who they were supposed to be serving were hazy at best.

As my colleagues and I contemplated the uncertainty of the times, we asked ourselves, “There has to be a better way, right?”

The ACQA was born

While those early ACOs were predominantly focused on costs, our vision was different. We had the goal of bringing cost control, quality outcomes, fair compensation, and provider collaboration together. So with blank paper in hand, we began meeting with area health systems. Ambitious for sure. But with the right approach rooted in partnership, we knew we could make it a reality.

It’s those partnerships and that groundwork that led to what we have in place today. Data identifies trends and opportunities, which are used to tailor a contract for each provider. We work alongside providers to develop agreed upon quality targets. Providers work toward those targets, and are compensated for meeting them.

When everything is working the way it should, providers have more time to do what they do best: deliver personal, patient-centric care. Members are healthier and spend less out-of-pocket. And we are able to better deliver on our mission of making high-quality, affordable health care accessible across upstate New York.

$100MM in efficiency savings was passed along to Excellus BCBS members.

Why ACQAs make sense

In practice, ACQAs are detailed, complex contracts. But the reason they’re catching on and making such big waves is because they address three fundamental, yet mammoth challenges facing health care today:

Lack of perceived value — Health care is expensive. People don’t feel their dollars are working hard enough. Delivering higher-quality care, eliminating inefficiency and waste, and controlling cost form the foundation of our philosophy. Better care for less is the definition of greater value.

Lack of alignment — Health care is a fragmented system that’s hard to navigate. A big part of what we bring to the table is the ability to aggregate data from disparate platforms and systems. Combining claims and clinical data creates a single view of the patient and ensures everyone’s on the same page.

Lack of care management ownership — Whose job is it to manage patients’ health? The answer here lies in the collaborative nature of ACQAs. Providers on the front lines have the ability to improve the health of the population, while we have the clinical and claims data to support them.

$10MM saved by identifying and maximizing the user of low-cost generic drugs.

The success is tangible — and just the beginning

ACQAs don’t just make sense in theory, they’re working in practice. In 2018 alone, a program designed to identify and direct members to low-cost drug equivalents saved $10 million. Tighter primary care relationships helped lower spending for emergency room use by $33 million. And ACQA providers contributed to an overall savings of $100 million, which we were able to pass along to members through lower premiums.

Our value-based approach is also contributing to an uninsured rate of just 3.5% in upstate New York, which is 61% lower than the national rate. And while it may not always feel like it, we enjoy some of the lowest health care costs in the country.

The uninsured rate in upstate New York is 61% lower than the national rate.

The best part? We believe these numbers will only improve in the years to come. As an organization, Excellus BCBS is in a unique position to continue to drive progress and change. We live here, work here, and are personally invested in creating better outcomes and healthier communities — and ACQAs are just one of the ways we’re doing this. We’ve spent decades building relationships with area providers and can be in their office the same day to answer questions and work together on improvements. We host local seminars and workshops to provide a platform for peer-to-peer collaboration and the sharing of best practices. Our ability to focus exclusively on Upstate New York while having the backing of the national Blue Cross Blue Shield network is one of our biggest strengths.

We’ve always believed that if you improve quality of care, everyone benefits and everything else you’re trying to achieve falls into place. Individuals and communities are healthier and able to enjoy a better quality of life. Providers are able spend more of their time helping people, which is why they got into their field to begin with. And where good health and patient-centric care pervade, lower costs are sure to follow.

It was the spark that began it all a decade ago and continues to be the heart and soul of our never-ending quest for higher-quality, more affordable health care.

Headshot photo of Paul Eisenstat
At the time of this article’s original publication, Paul Eisenstat served as the SVP Health Care and Network Management at Excellus BCBS. Paul's Excellus BCBS career focused on building successful relationships among providers, payers and consumers of health services. In his over 11 years with Excellus BCBS, he helped drive programs with the dual aim of improving population health while containing costs. These included medical and pharmacy clinical strategies, formation of provider partnerships, and the shift from volume to value-based payment (VBP).