PCMH, Affordable Care, Care Delivery, Healthcare Transformation, Cost Control, Quality Care, Coordinated Care, Quality Outcomes
Working for quality care

Leading Critical Healthcare Reforms

Posted by Eric Lail and Elizabeth Casey

Blue Cross and Blue Shield companies pioneered the concept of health insurance for Americans, and our legacy of leading the way for the industry endures today.  From the enactment of Medicare and Medicaid, to the creation of HMOs and PPOs, The Blues® have helped to guide industry innovation for more than 80 years.

Today, that means working to find ways to rein in the costs of a $2.8 trillion healthcare system that delivers too many medical services that are ineffective or redundant, and improving overall quality of care for our Members.  The Blues believe that our healthcare system should deliver safe, high-quality care; eliminate inefficient spending; and encourage and reward actions that individuals take to improve their health.

To accomplish this, the Blue System is addressing key components of care delivery and collaborating with physicians and other stakeholders, rather than simply shifting costs across the system.  Blue Cross and Blue Shield companies already offer more than 350 value-based care delivery programs and we continue to work to generate programs that lead to a healthcare system in which care is safer, better coordinated, more affordable and provides better outcomes for patients.

Some of the innovative programs implemented by the Blues will be on display on February 27, when leaders from CareFirst BlueCross BlueShield, Independence Blue Cross and the Blue Shield of California Foundation will participate in The Aspen Institute and The Advisory Board Company’s Care Innovation Summit 2014. The event will feature discussion among a range of leaders in the healthcare industry, including policymakers from both sides of the aisle, medical professionals and others.

Chester “Chet” Burrell, president and CEO of CareFirst BlueCross BlueShield – which serves residents in Maryland, Washington, D.C., and portions of northern Virginia - will discuss how CareFirst is improving healthcare quality and affordability through ground-breaking partnerships with doctors and other medical professionals. CareFirst BlueCross BlueShield’s Patient Centered Medical Home (PCMH) initiative includes 3,600 primary care doctors and nurse practitioners caring for 1 million CareFirst members.  Doctors are given incentives to better manage the care of chronically ill patients, allowing them to better control their diseases and avoid costly medical procedures.  CareFirst local care coordinators partner with the physicians in these practices to assist in things like coordinating care after a patient is discharged from the hospital, or making office visits to discuss patients’ care plans. There are also regular, web-based updates to records so they are available to the entire care team.

In 2012, these physician-patient partnerships produced more than $98 million in savings, while quality scores that are based on outcomes for patients also rose.  

The CareFirst program is just one example of the initiatives Blue Cross and Blue Shield companies are developing to provide safe and high-quality care for members. Programs like these are among the many reasons why generations of Americans have turned to Blue Cross and Blue Shield companies for the past 80 years to provide the state-of-the-art health insurance coverage they need, with the security and stability they’ve come to expect. 

PCMH, Affordable Care, Care Delivery, Healthcare Transformation, Cost Control, Quality Care, Coordinated Care, Quality Outcomes

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