Blue Shield of Calif. aims to help independent doctors with value-based care

Blue Shield of California unveiled new details on Thursday about the technology and services company it is launching to help physician practices remain independent while giving them tools needed to succeed in value-based care arrangements.

A week after Blue Shield christened the new company Altais — named after a giant star — it announced Altais is partnering with the California Medical Association and Aledade, a Bethesda, Md.-based company that helps physicians launch accountable care organizations; the company and its partners will offer independent doctors and practices tools to improve patient health outcomes while making it easier for them to focus on care instead of administrative tasks.

Blue Shield also said it plans to support physicians in moving toward value-based care by investing in their practices. Investments could range from different types of affiliations to even employing the doctors in select situations, though employment it not the primary objective, said Dr. Jeff Bailet, Altais’ CEO and former executive vice president of healthcare quality and affordability at Blue Shield

“We’re hoping to keep these practices independent and vibrant, but we will make investments and provide services and tools to help them,” Bailet said in an interview.

Blue Shield created Altais because fewer and fewer doctors are staying independent. Physician practices are burdened by administrative work and sometimes can’t afford to upgrade their technology or acquire tools to succeed in new payment models, Bailet explained.

Burned out doctors may feel compelled to retire early or join health systems or other organizations that employ physicians, which leaves patients having to find a new doctor or learn to navigate a health system, he said.

“When these physicians go from independent practice into an integrated delivery system, the costs go up, and one of our objectives is to make healthcare more affordable,” he said. “So keeping physicians independent but professionally gratified and technologically enabled is very, very important.”

A wealth of research backs him up. Economists say it is well-established that consolidation among healthcare providers increases costs. A 2014 study by Stanford University researchers also found that hospital acquisition of physician practices led to significant increases in hospital prices and spending.

In California, the percentage of physicians in practices owned by a hospital increased from 25% to more than 40% between 2010 and 2016, according to a 2018 study funded by the Commonwealth Fund. The same study found that hospital acquisitions of physician practices is associated with higher prices for outpatient visits and higher insurance premiums in the individual marketplace.

Health insurers have also started employing doctors in a bid to gain better control over spending. UnitedHealth Group’s healthcare services subsidiary Optum has led the charge to buy medical practices; most recently it bought DaVita’s medical group, which employed more than 750 primary-care physicians.

Blue Shield’s Altais venture appears to share some similarities with Optum, though a spokesman emphasized that Altais is unique in that it will focus on physicians and clinicians and deliver more help and support while reducing burden beyond what other technology companies provide. A previous news release also said Altais is in discussions to deliver primary and specialty care.

Altais is collaborating with Aledade to offer a set of tools to help physicians succeed in value-based care models. Those tools include population health support, predictive analytics, as well as tools that reduce burden by providing real-time transcription of a patient visit, for example. Altais will also help with back-office functions like billing and credentialing.

“Physicians are happier when they aren’t employed by a big health system, when they’re part of physician-owned practices. That’s what we are trying to maintain by reducing the burnout, and the feeling of being a cog serving a bigger machine,” said Dr. Farzad Mostashari, CEO of Aledade, which works with over 450 physician practices in 25 states.

For its part, the California Medical Association will help to identify independent physicians and practices that need support and make introductions.

The three organizations will work with payers in the state to offer value-based arrangements to reward physicians for better care. Blue Shield has committed to offering such an arrangement for primary care in 2020 to physicians working with Altais and Aledade. Aledade is already collaborating with the California Medical Association to create physician-led accountable care organizations to participate in the Medicare shared-savings program.