What a doctor can do for you with value-based care

Published June 22, 2018

Dr. David Shin practices internal medicine at Alle-kiski Medical Associates, just northwest of Pittsburgh, Penn. For Shin, value-based care, the kind of arrangement that pays doctors for providing high-quality care while managing costs, isn’t a string of buzz words. It’s a new way of providing proactive, holistic care for a population of patients, one person at a time. Highmark Blue Cross Blue Shield’s True Performance program gives Shin some new tools to do that.

A couple with diabetes struggles at the food bank
Shin recalls a couple with diabetes and heart disease whose health wasn’t improving, even though they were taking their medications and going to doctor’s appointments. Shin warned the couple about their elevated sugars, swelling legs, and shortness of breath; but Shin didn’t know why these patients weren’t improving. He probed for more information. And that’s when he learned the real reason. 

“They said, ‘Listen, we can’t afford the right food that we’d like to eat,’” Shin recalls. “’We have to go to the food bank,’” they told him. Shin tapped a nutritionist on his team. “And in two hours, they were able to put together a diet based on what they got from the food bank.” Shin says their numbers are starting to improve, “but, more importantly, they feel a lot better.”

Extra resources for doctors help them provide holistic, continuous care
Shin and his practice have been able to add resources like diabetic nutritionists, nurse care coordinators and health coaches thanks to a value-based care program from Highmark Blue Cross Blue Shield called True Performance. He adds, “There was no reimbursement for that kind of care before.”

Value-based care arrangements typically:

  • Support doctors who are willing to go the extra mile with investments in practice resources like staff or technology.
  • Measure and reward high-quality practices, such as those that see improvements in controlling their patients’ diabetes or reduce emergency room visits.
  • Provide claims data to help doctors understand – and possibly follow up on – their patients’ experiences inside and outside the walls of their practice.

“True Performance empowers doctors with claims data, and some forthcoming tools that will help them do even more, such as predict the likelihood of future medical needs or the impact of socioeconomic factors on a patient’s health.”Highmark Blue Cross Blue Shield’s Chief Medical Officer, Dr. Charles DeShazer, on the power of data

The numbers are in: high performance care reduces costs
Using those tools, Highmark Blue Cross Blue Shield’s True Performance program has achieved impressive results. Nearly three-quarters of the health plan’s providers participate in the program, serving about two million members. And clearly, improving quality is also saving money. Emergency room utilization is down 13 percent and hospitalizations have decreased 16 percent. That’s partly why, in the first half of 2017, the program avoided $180 million in costs.

Value-Based Care Infographic


Highmark Blue Cross Blue Shield’s director of value-based operations, Mary Vandenburg, says primary care physicians like Shin have a huge influence on the cost of care. 

“They can influence up to 80 percent of medical costs,” Vandenburg says. That’s because they are often the starting point for referring patients to specialty care, imaging and more. Those kinds of treatments may be precisely what’s needed, but when the primary care physicians are able to manage some health needs, before they worsen, care is less expensive.

For doctors like Shin, these new arrangements are much more satisfying. He says he has the resources and the time to take care of patients in ways he couldn’t before. Patients get and stay healthier, costs go down, and Shin and his colleagues have incentives to do even better the following year.

Highmark Blue Cross Blue Shield is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.