Blues are shaping the future of value-based care

Published April 26, 2018

Value-based care – done well – can improve the quality of care patients receive and drive down costs throughout the healthcare system. There’s no single recipe for the ideal patient-focused care program. But data show the most successful programs combine some key ingredients:

Doctor shaking a patient's hand while a nurse looks onThrough their strong relationships with local doctors, nurses and hospitals, Blue Cross and Blue Shield companies are driving innovations in value-based care that lead to measurable healthcare improvements. It’s all about ensuring members receive the right care in the right setting at the right time, while making healthcare more affordable. Here are a few examples of innovative patient-focused care programs delivering results:

Measuring quality

Wellmark Blue Cross and Blue Shield’s (Wellmark BCBS) Accountable Care Organizations (ACOs)use the Value Index Score (VIS)™ to measure the quality of care a doctor provides to each patient, regardless of his or her health status. It’s a single score that quantifies the quality of care on 16 measures. So far, Wellmark BCBS’ ACOs have delivered savings of more than $16 dollars per member per month, reduced hospital admissions by more than 20 percent, and boosted health and wellness screenings.

Gaining insights from shared data

Blue Cross and Blue Shield of Kansas City (BCBS Kansas City) empowers physicians in its patient-centered medical home program to derive insights from patient data through its clinical and financial “dashboards.” A patient registry helps providers assess each patient’s needs in order to improve chronic conditions and help patients make healthier lifestyle changes. A clinical analytics tool helps practices identify groups of at-risk members who would benefit from additional outreach. Since its inception, BCBS Kansas City’s program has lowered the total cost of care for participants while providing increased access to care, reduced emergency room visits, increased screenings for breast, cervical and colorectal cancer and improved outcomes for all diabetes-related measures.

Adding resources to coordinate care 

Blue Cross and Blue Shield of South Carolina deploys dedicated Innovation Specialists to its patient-centered medical homes to help physicians transform their practices across leadership, clinical and administrative levels to improve patient health and address costs. In 2017, the program resulted in a 9 percent decrease in emergency room visits for medical home patients. Per member per month claims for members in these practices were 6 percent lower. And hospital admission rates were 10 percent lower per 1,000 patients.

Paying for performance

Blue Cross and Blue Shield of Alabama’s “Primary Care Select” program offers participating providers a “Select” fee schedule and the opportunity to earn 30 percent above that schedule by maintaining patient focus, clinical effectiveness and cost-efficiency measurement thresholds. The program has resulted in better health outcomes for patients and improved performance from providers. Among participating providers, there was a 15 percent increase in National Committee for Quality Assurance (NCQA) Recognition qualifiers as part of Primary Care Select Program value-based payment incentives. There has also been a 15 percent increase in after-hours access for patients, resulting in additional reimbursements for providers.

Innovating to improve care for populations with unique needs

Blue Cross & Blue Shield of Rhode Island’s HealthPath program provides a bundled monthly payment to providers to cover all behavioral health services – including supportive services that have not traditionally been covered by commercial insurers. The program encourages coordinated, comprehensive, community-based treatment that addresses overall behavioral health spending. Per capita mean healthcare costs for patients who complete the program are nearly a third less than for participants who do not complete the program.

Wellmark Blue Cross and Blue Shield, Blue Cross and Blue Shield of Kansas City, Blue Cross and Blue Shield of South Carolina, Blue Cross and Blue Shield of Alabama and Blue Cross & Blue Shield of Rhode Island are independent licensees of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.