; Blue Cross And Blue Shield Companies Testify On Capitol Hill About Innovative Programs To Improve Quality And Value
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Blue Cross And Blue Shield Companies Testify On Capitol Hill About Innovative Programs To Improve Quality And Value

CareFirst BlueCross BlueShield and Blue Cross Blue Shield of Massachusetts discuss programs with Senate Finance Committee Roundtable

June 14, 2012

WASHINGTON – On Capitol Hill today, two Blue Cross and Blue Shield companies highlighted innovative collaborations with providers and new payment models which are helping to improve the quality and value of care that patients receive.  Representatives of CareFirst BlueCross BlueShield (CareFirst), headquartered in Maryland, and Blue Cross Blue Shield of Massachusetts (BCBSMA) testified before the U.S. Senate Committee on Finance Physician Payment Roundtable on "Medicare Physician Payment Policy: Lessons from the Private Sector."

Chet Burrell, president and CEO of CareFirst, discussed the company's innovative patient-centered medical home (PCMH) program designed to provide primary care providers with new incentives and tools to provide higher quality, lower cost care to Blue members.

Understanding that 10 percent of CareFirst members account for 60 percent of the costs for healthcare services, and that nearly 80 percent of these patients suffer from multiple chronic conditions, CareFirst's PCMH program is designed to enable physicians to closely coordinate care for the chronically ill, as well as help these patients better manage their diseases and improve their overall health.

"Our PCMH program is a model that is easily scalable as it is moving the region toward a new healthcare financing model that uses the incentives inherent in a global capitation model to counteract the volume-inducing aspects of fee-for-service, but without shifting risk to primary care providers who are not in a position to assume those risks," said Burrell in his testimony.

Last week, CareFirst announced the results of its first full year of its PCMH initiative.  With nearly 3,600 participating primary care providers, providing care for nearly one million of CareFirst's members, Burrell reported that nearly 60 percent of eligible PCMH Panels (small teams of primary care physicians and nurse practitioners) earned increased reimbursements for their performance in 2011.

Representing Blue Cross Blue Shield of Massachusetts, Dana Gelb Safran, senior vice president for performance measurement and improvement, shared details of Blue Cross Blue Shield of Massachusetts' Alternative Quality Contract (AQC), which has been in place since 2009.  The AQC employs a population-based global budget with significant financial incentives for performance on a broad set of quality and outcome measures.

"The model establishes provider accountability of clinical quality, patient health outcomes, and overall medical spending and cost growth,” said Safran during her testimony.  "It is now our predominant payment model – in place with more than three-quarters of our provider network."

Safran also noted that AQC providers now significantly outperform the rest of BCBSMA's fee-for-service network on a comprehensive set of quality and outcome measures.  This is particularly true in managing chronic illness, preventive care screenings and treating depression.  Recent independent studies conducted by Harvard Medical School, published in the New England Journal of Medicine, and Brandeis University, published in Health Affairs, found that the AQC is achieving its twin goals of improving care and slowing costs.

The testimony is available online on the Senate Finance Committee website. To learn more about initiatives in your area, please contact your local Blue Cross and Blue Shield company or visit http://www.bcbs.com.

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.