Value-based care: Blue Cross program reduces costs by 35%
Blue Cross Blue Shield shared data showing what's working in its own efforts.
Lowering costs and improving care quality is a top goal for the healthcare industry and, as such, alternative payment models are emerging among hospitals and health insurance companies. But at this point in the transition from fee-for-service to value-based care it has been difficult to pinpoint exactly what works and what does not when it comes to achieving the goal of higher quality care at lower costs. The Blue Cross Blue Shield Association just gave a glimpse of where it has achieved success.
It's announcement comes on the heels of Humana last week ratcheting its value-based program up to focus more on patient experience, quality and improvement and in a separate move introducing an episode-of-care model that it said will incentivize Ob-Gyns to drive better outcomes. And the American Medical Association this month also revealed plans to pilot an alternative payment model specifically geared toward treating patients who have opioid use disorder.
[Also: Humana launches maternity bundled payment model with analytics and care coordination capabilities]
Offering evidence of the potential that value-based partnerships between hospitals and payers holds, BCBS said that its Blue Distinction Total Care Program has already decreased costs by 35 percent for participants when compared to other providers that did not participate.
Launched in 2015, Total Care is a national network of value-based care programs demonstrating measurable improvements in the management of chronic conditions such as diabetes, asthma and cardiovascular disease, BCBSA said.
Total Care programs are part of the BCBS System's slate of value-based care programs, which include ACOs, Patient-Centered Medical Homes pay-for-performance programs and episode-based payment programs.Sharing data to coordinate and monitor patient care, and shifting to reimbursement models that stress quality over quantity, are the primary hallmarks of the program's performance.
Overall, Total Care doctors, hospitals and clinical care teams are performing better than other providers in 96 percent of the quality measures tracked. And it's also driving an increase in preventative medicine, including pediatric health screenings and immunizations.
Participants achieved a reduction in medical costs that include 275,000, or 10 percent, fewer emergency department visits; 7 percent better HbA1c testing for diabetes patients; 5 percent better adherence to medications for patients with cardiovascular disease; and a 15 percent decline in hospitalizations year-over-year.
Although they only track one program's success, the BCBS findings represent potential significant savings across the broader healthcare system and demonstrate that by emphasizing prevention and wellness, providers are holding the line on costs by keeping patients out of the hospital.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
