Large hospital systems often have more resources to provide an extra level of care for patients. But small community hospitals may sometimes have to do more with less. That’s why Blue Cross Blue Shield of Massachusetts (BCBS Massachusetts) is working with one such community hospital to make extra resources available while holding it accountable for providing quality, affordable care for the community.
A community hospital poised to do more for its community
South Shore Hospital is a 393-bed, Level II Trauma Center – able to provide definitive care for a high volume of injured patients - in historic Weymouth, Mass. It’s the only such facility South of Boston. Like other hospitals, South Shore’s biggest revenue stream is from hospital admissions and ER visits. While South Shore CEO Gene Green says hospital admissions and ER visits may be exactly what a patient needs, the arrangement with BCBS Massachusetts means that “now we can focus on other important needs, like community health.”
BCBS Massachusetts executive Matthew Day boils the new model down to this: South Shore will be accountable for the health of its community and for reducing the overall medical expenditure trend for BCBS Massachusetts members. If the hospital makes progress toward those goals, BCBS Massachusetts will pay the hospital a higher reimbursement rate. Higher reimbursements are intended to give the hospital the help it needs to develop valuable community health services, like home care, telemedicine, or an urgent care clinic.
“Not every patient needs to go in a bed,” says Day. Hospital overnights are among the most expensive services, although sometimes they are absolutely necessary, and both health plan and hospital officials are committed to ensuring patients receive the right care in the right place at the right time. “But some patients might do well with telemedicine or other outpatient services,” says Day. Some patients, he says, may simply need a home visit to help avoid being readmitted to the hospital.
Essentially, South Shore CEO Gene Green says, “we will work collaboratively with BCBS Massachusetts to find a way to meet the needs of our patients.”
Hospitals and local doctors need to collaborate
To succeed, Green and Day say clinicians from the hospital and local doctors’ offices will have to collaborate and share medical records to ensure coordinated patient care. For example, if a patient shows up in South Shore’s ER, Green says his staff will want to communicate with the patient’s primary care doctor to ensure the right follow up care takes place and a readmission is avoided. If a patient needs surgery that can be performed in a nearby outpatient surgery center, Green says his doctors can make the referral without worrying about losing business. The overall medical expense is lower and the patient receives the same high quality care.
BCBS Massachusetts believes such coordination means patients will receive better care and avoid unnecessary treatment. That kind of coordination is increasing across Massachusetts, but health plan representatives say this is one of the first such agreements with a smaller, independent community hospital.
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Blue Cross Blue Shield of Massachusetts is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally owned and operated Blue Cross and Blue Shield companies.