; Blue Cross And Blue Shield Companies Support New Healthcare Models
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Press Release

Blue Cross And Blue Shield Companies Support New Healthcare Models

Collaborations with doctors and hospitals are improving quality and value for consumers

May 12, 2011

WASHINGTON – The Blue Cross and Blue Shield Association (BCBSA) applauds the House Ways and Means Health Subcommittee for convening today’s hearing to explore new models for delivering and paying for healthcare services that improve quality of care and help attack costs for consumers.

Blue Cross and Blue Shield (BCBS) companies agree that the healthcare system needs to change.  That’s why the Blues are working with doctors and hospitals nationwide to develop new ways to improve the quality of care you receive and attack rising healthcare costs within the system.

“Blue Cross and Blue Shield companies are committed to better health and better healthcare value,” said Scott P. Serota, BCBSA president and CEO.  “We’re working closely every day with doctors and hospitals nationwide to develop new solutions to make sure the care patients receive is better – in both quality and value.”

At today’s hearing, Dana Safran, senior vice president for performance measurement and improvement at Blue Cross Blue Shield of Massachusetts (BCBSMA), shared with the committee how BCBSMA’s Alternative Quality Contract (AQC) is encouraging cost-effective, patient-centered care by paying participating physicians and hospitals for the quality, not the quantity of the care they deliver.  This new contract model combines a per-patient global budget with significant performance incentives based on nationally endorsed quality measures tied to quality, health outcomes, and patient experience.

“At BCBSMA, our highest priority is to make quality healthcare affordable for individuals, families and employers who have made us the health plan of choice in Massachusetts,” said Safran.  “The Alternative Quality Contract is providing evidence that improvements in both healthcare quality and spending are achievable through a payment model that establishes provider accountability for quality, outcomes and costs.”

BCBSMA’s AQC is one of the largest payment reform initiatives in the country.  The global payments are adjusted for age, sex, and health status of patients and cover all services received by a patient, including primary, specialty, and hospital care.  So, when a doctor spends more time with a patient and helps the patient successfully manage a chronic medical condition, like hypertension or diabetes, the result is both improved health outcomes for the patient and lower overall costs by helping avoid unnecessary hospitalization.  Employers and employees/members benefit as the new system moderates cost increases and hence health insurance premiums through better care.

The first AQC was signed in January 2009.  Today, one-third of physicians in BCBSMA’s HMO network (about 6,600 physicians) are in an AQC arrangement.  These physicians care for nearly a half million Massachusetts residents.  First-year results show the AQC is on track to achieve its original goal of reducing annual healthcare cost trends by one-half over the five years of the AQC contracts.

Blue Cross and Blue Shield companies are collaborating with doctors and hospitals across the nation on dozens of initiatives to improve the quality of care, patient safety and lower costs for consumers.

Blue Distinction® is a nationwide designation program developed by BCBSA to recognize medical facilities that have demonstrated expertise in delivering quality healthcare above and beyond its peers. The designation is based on rigorous, evidence-based, objective selection criteria established in collaboration with medical experts’ recommendations.  Its goal is to help consumers and their physicians find quality specialty care on a consistent basis, while encouraging healthcare professionals to improve the overall quality and delivery of care nationwide.

  • Blue Distinction Centers for Bariatric Surgery®  have a 26 percent lower complication rate for bariatric surgery, a 22 percent lower readmission rate for laparoscopic gastric bypasses,1 and deliver laparoscopic adjustable gastric banding at an average cost of 11 percent less than other facilities.

  • Blue Distinction Centers for Cardiac Care® have lower rates of hospital readmissions by 32 percent for outpatient angioplasties and 21 percent for cardiac bypass surgeries, at cost savings that average 11.8 percent and 4.8 percent less, respectively, compared to other facilities. 

Some examples of BCBS companies’ collaborations that are developing new models for delivering and paying for healthcare services include: 

  • Blue Cross and Blue Shield companies have launched more than 45 unique patient-centered medical home (PCMH) programs across the country to treat people with chronic conditions.  PCMHs promote greater patient involvement and interaction with their primary care physician and increase use of health information technology.

  • In Blue Cross and Blue Shield of Michigan’s PCMH program, the largest of its kind in the country, practices designated as a patient-centered medical home had 25 percent fewer ambulatory-care sensitive inpatient admissions, and had ER utilization 2.8 percent lower among adults and 7 percent lower among children, compared to non-designated participating practices in the first six months of 2010.

  • Independence Blue Cross’ PCMH program in southeastern Pennsylvania resulted in 50 percent more people having well-controlled diabetes, 70 percent had more well-controlled cholesterol, and 38 percent had more well-controlled blood pressure over three years.  In addition, two-thirds more children with asthma established personalized asthma action plans with their physicians and are more prepared to prevent a serious asthma attack.

  • Highmark Blue Cross Blue Shield’s QualityBLUE pay-for-performance program has catalyzed quality, safety and efficiency improvements among 63 participating hospitals and more than 5,000 primary care physicians by redesigning payment incentives to reward better outcomes and providing the tools providers need to transform care.  To help participating providers succeed in improving care, a dedicated team of QualityBLUE improvement coaches partners with hospitals and physician practices on implementing electronic health records (EHRs), improving chronic disease management, and adopting proven infection prevention techniques.  Four year central line and two year MRSA experience together with current year adverse events:  $52 million in case cost savings, 2011 averted adverse events, and most importantly an estimated 168 to 335 lives saved.  Meanwhile, participating physicians significantly outperformed national benchmarks for delivering recommended care such as well-child visits and mammograms, while boosting their utilization of safety-enhancing technologies like e-prescribing and EHRs.

  • Blue Cross and Blue Shield of North Carolina’s Blue Quality Physician Program (BQPP)SM is a program for primary care physicians who act as a PCMH.  BQPP encourages improved clinical outcomes, administrative efficiency, and patient experience, as well as cost and efficiency of care through higher reimbursement for successfully completing specific healthcare delivery improvement programs and delivering high-quality, efficient care.  BCBSNC paid $4.2 million in rewards to physicians during a three-year pilot to encourage better efficiencies in practice management – which includes information systems, patient education and care coordination.  Patients treated by physicians with these recognitions showed 52 percent fewer visits to specialists, 70 percent fewer visits to the emergency room, lower high cost radiology costs, slightly lower inpatient utilization and lower average lengths of stay.

To learn more about how Blue Cross and Blue Shield companies are improving healthcare in their local communities, visit BCBS.com and http://www.bcbs.com/innovations/bluedistinction/


The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 105 million members – one-in-three Americans.  For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.