BCBSA News Media Tip Sheet (Better Quality, Lower Cost)
April 11, 2011
Better Quality, Lower Cost
The Blues: Attacking Cost Drivers And Improving Quality Of Care
As healthcare costs continue to increase, Blue Cross and Blue Shield companies across the country are employing new and creative ways to address primary cost drivers to help make healthcare more affordable.
While some healthcare experts are still weighing the potential value of an Accountable Care Organization (ACO), Blue Shield of California's ACO - the first in that state - has already produced results, improving the quality of care while lowering costs. Launched in January 2010 - months before the passage of federal health reform - the project is expected to exceed its cost savings target of $15.5 million while ensuring no premium increase for the program's 40,000 members. Preliminary outcomes from the ACO include a 22 percent drop in inpatient readmissions. That success has spawned other collaborations as part of an ambitious plan by Blue Shield to have 20 ACOs in place across the state by 2015. Blue Shield recently announced two new ACOs for the San Francisco Health Service System set to launch in July.
In Washington, Premera Blue Cross has been lowering healthcare costs through its innovative work with Microsoft since 2006. To address high emergency room use, Microsoft employees needing non-emergent care were encouraged to contact Premera’s 24-hour NurseLine where a registered nurse would offer appropriate care options, including self-administered care, referrals to urgent care facilities, or home visits by a certified physician. Over the past four years, this program has resulted in significant health cost savings for the company and improved the health of Microsoft employees through the discovery of other conditions during home visits. Encouraged by these positive results, Microsoft is contemplating an expansion of the program to assist even more employees and Premera has recently launched its Home Visit Program, broadening its reach to more Premera members and markets.
Building on the relationship between medical directors, nursing and non-clinical staff, Anthem Blue Cross and Blue Shield’s Readmissions Prevention Program helped to reduce the percentage of Medicare Advantage patients who were readmitted to the hospital in its central region from 18.4 percent in 2009 to 17 percent in 2010. Readmission rates in the program were lower than the typical 20 percent Medicare readmission rate and resulted in a $7.7 million savings for patients. WellPoint teams help identify high-risk patients while they are still in the hospital and meet regularly with patients and nursing staff, which has led to a markedly increased number of “touches,” which help to enhance nurse’s interactions. Improved follow-up care also includes phone calls and leveraging local resources to close gaps in care at home.
For more information, contact Kelly Miller, kelly.miller@bcbsa.com, 202.626.4825.
