The actual cost of providing health care to commercially-insured Blue Cross and Blue Shield members attributed to a value-based program was $17.35 per member, per month below the network average during 2017, according to Michael D. Atwood, M.D., CHIE, vice president of medical affairs and chief medical officer for Blue Cross and Blue Shield of Kansas.
"That is a significant number that shows our value-based programs are beginning to prove that better coordinated and patient-centered care can result in better health, better experiences and lower total cost of care," Dr. Atwood said.
More than 575 providers served 191,500 Kansans who were attributed to either a patient-centered medical home (PCMH) or an accountable care organization (ACO) during 2017. Both ACOs and PCMHs are created through special provider contracts and are focused on improving the overall quality of health care, creating better experiences for members and better controlling the total cost of care for a sustainable future.
Atwood pointed to another number that he said shows value-based programs are working: The cost of care required for those members with chronic health conditions attributed to a value-based program was $6.50 per member, per month less during 2017 as compared to those with chronic conditions who were not attributed.
"When you consider that the roughly one-third of members who have chronic conditions account for about two-thirds of the total cost of care, it becomes evident that one way to lower health care costs for all is to do a better job of efficiently coordinating care for those with chronic conditions," Dr. Atwood said.
Other key results from 2017 program year data include:
- 8.1 percent fewer hospital admissions than the network average
- 6.43 percent fewer emergency room visits than the network average
- 17.56 percent fewer hospital readmissions than the network average
Value-based provider contracts are designed to reward providers for meeting pre-determined quality and cost metrics; value-based contracts do not replace traditional fee-for-service arrangements, but rather add extra incentives to improve population health and member experiences while reducing overall health care costs over time.
Under an ACO model, usually signed with a hospital and its integrated health care system or a large group of primary care professionals, quality and cost targets drive provider incentives, improve health and reduce health care costs increases over time. The PCMH model, which includes special contracts with professional providers, requires participating primary care providers to deliver care that is comprehensive, continuous, coordinated and committed to helping patients reach their overall health goals.
About Blue Cross and Blue Shield of Kansas
For more than 75 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust with its members and contracting providers by providing outstanding customer service while quickly and accurately processing claims; fairly administering benefit plans and contracts; offering programs, services and tools to help members improve or maintain their health; and operating under the highest ethical standards while being good stewards of premium dollars. Blue Cross and Blue Shield of Kansas is an independent licensee of the Blue Cross Blue Shield Association and is the state’s largest insurer, serving all Kansas counties except Johnson and Wyandotte. For more information, visit bcbsks.com.