Capital BlueCross Accountable Care Arrangements Yielding Improved Care, Healthier Customers

HARRISBURG – Capital BlueCross has announced that its Accountable Care Arrangements, an innovation that the company first introduced in 2011, are yielding excellent results including improved quality of care, healthier customers, and lower health care costs.

“As health care continues to evolve at a rapid pace, it is important for health insurers to remain focused on finding better ways to improve the quality of care, while putting downward pressure on the rising cost trend,” said Dr. Jennifer Chambers, Capital BlueCross senior vice president and chief medical officer. “We have done just that over the past four years by collaborating with area providers to implement Accountable Care Arrangements throughout the region. Not only has our model been enthusiastically embraced by physicians and their patients, but this holistic approach to medical care is working as we had hoped.”


Data from physicians who have participated in a Capital BlueCross Accountable Care Arrangement for at least one full year show that:


  • Accountable Care Arrangements are meeting or exceeding agreed-upon quality goals relating to chronic disease management, helping patients who have chronic conditions such as diabetes, coronary artery disease, and congestive heart failure experience improved health.
  • More specifically, Capital BlueCross’ Accountable Care Arrangements are exceeding the regional average for Healthcare Effectiveness Data and Information Set (HEDIS) measures for some of the leading chronic diseases. For example, several participating providers have demonstrated performance of greater than the 95th percentile for the Comprehensive Diabetes Care measure and greater than the 90th percentile for the Cholesterol Management for Cardiovascular Conditions measure.

Note: HEDIS is a comprehensive tool used by most health plans to measure performance on important aspects of care and service.

  • One of Capital BlueCross’ longest standing Accountable Care Arrangements achieved greater than the 95th percentile in these Consumer Assessment of Healthcare Providers and Systems, Clinician & Group Surveys (CG-CAHPS) categories: Composite: Getting Timely Appointments, Care, and Information; Composite: How Well Doctors Communicate With Patients; and Doctor’s Office Followed Up To Give Test Results.

Note: Capital BlueCross’ Accountable Care Arrangements use CG-CAHPS to ask patients about their recent experiences with clinicians and their staff, and to measure and hold individual providers accountable for patient satisfaction.

  • Data for a recent 12-month period show that Capital BlueCross’ Accountable Care Arrangements are outperforming their peers for the following measures:
    • Acute inpatient admissions are 4.7 percent lower for employer group customers, and 7.2 percent lower for Medicare plan customers
    • Readmissions are 8 percent lower for employer group customers and 14.8 percent lower for Medicare plan customers
    • Emergency room visits are 8.4 percent lower for employer group customers and 8.2 percent lower for Medicare plan customers
  • Medical and pharmacy costs for Capital BlueCross Accountable Care Arrangements are growing at a lower rate than Capital BlueCross’ total book of business, and compare favorably against similar arrangements implemented by other Blue Plans across the country.

Under the Accountable Care Arrangement model, Capital BlueCross partners with primary care physician practices to provide dedicated care management resources and technology to deliver patient-centered, holistic care. By optimizing the use of technology-enabled tools, such as a Population Management Tool, customers with complex medical conditions or those at risk for a condition are identified for outreach, education, and referral for additional clinical, wellness, or community-based services.

The company currently has seven Accountable Care Arrangements throughout central Pennsylvania and the Lehigh Valley, with both independent physician groups and integrated delivery systems that serve more than 100,000 Capital BlueCross customers.

Capital BlueCross has also introduced a program geared toward small to mid-sized, independent primary care physician practices that are not part of an integrated delivery system and that would likely not have an opportunity to participate in a regular ACA. QualityFirst rewards eligible primary care physicians for best value in delivering high-quality, efficient, patient-centered care to Capital BlueCross customers. The QualityFirst Program affects over 130,000 members.

Capital BlueCross has a long history of bringing innovative programs like Accountable Care Arrangements to its customers and communities to help increase quality, reduce costs, and improve satisfaction.

About Capital BlueCross
For more than 75 years, Capital BlueCross has served residents and businesses in central Pennsylvania and the Lehigh Valley as the region’s leading health insurer. Delivering value through innovation and collaboration, Capital BlueCross continues to evolve, investing in products, services and partnerships to create an even healthier future for customers with more choice, greater convenience and enhanced quality of care. Through Capital Blue, the company’s one-of-a-kind health and wellness retail store, consumers have a place to go for in-person health insurance consultation and service, and for health and wellness information and programs, in a welcoming, convenient environment. Headquartered in Harrisburg, Pa., Capital BlueCross is an independent licensee of the Blue Cross and Blue Shield Association employing more than 1,800 people. For more information, visit


About Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 35 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.