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HSS staff directed to draft policy reserving excess underwriting gains for ACO incentive payments after Blue Shield ACO review
Summary
After presentations from Blue Shield and local medical groups showing reductions in inpatient days, readmissions and ER visits, the Health Service System board directed staff to develop a policy to reserve underwriting gains to fund ACO incentive payouts and clarified how unused funds would revert to the Blue Shield stabilization reserve.
The San Francisco City Health Service System board directed staff to develop a formal policy to reserve excess underwriting gains to pay ACO incentive targets after a detailed presentation on the Blue Shield ACO model and early results.
Director Catherine Dodd outlined the ACO approach and said the program has produced measurable improvements: inpatient days per thousand down 8.1%, average length of stay down 10%, 30‑day readmissions down about 7.2%, emergency‑department visits down 7.7%, and generic prescription…
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