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Blue Cross Blue Shield Association expands value-based network to national employers

Blue Distinction Total Care estimated to save $840M annually over fee-for-service model

In order to accelerate the transition away from fee-for-service healthcare, the Blue Cross Blue Shield Association (BCBSA) will now make 450 local, value-based care programs available to multi-state employers, the organization announced Tuesday.

Blue Distinction Total Care will be the industry's largest national network of patient-focused care programs, according to the announcement, and the BCBSA estimates that the Total Care network will save it more than $840 million annually compared to traditional payment models.

The initiative made sense because large, multi-state employers are increasingly looking for value in their healthcare dollar, BCBSA Chief Strategy Officer Maureen Sullivan tells FierceHealthPayer in an exclusive interview.

"Total Care is the only solution in the market that's national," she says. "It really enables an employer to find these local market innovations for their employees and to ensure that it's really seamless back to back."

The network currently includes nearly 118,000 medical professionals and covers nearly 13 million Blues plan members--and the BCBSA expects the latter figure to grow as more national employers participate in the network. BCBSA member companies directed more than $145 billion per year in medical spending through Total Care's select value-based programs in 37 states, or more than a third of the association's total annual medical claims, from from July 1, 2014, through June 30, 2015.

These value-based programs include patient-centered medical homes, accountable care organizations, pay-for-performance programs and episode-based payment programs. The BCBSA decided to include a breadth of models because different ones work better among different populations, according to Sullivan. "Each one has a positive story to tell," she says, even if some have longer track records of success than others.

But despite their differences, the network's value-based care programs all were chosen based on nationally consistent criteria, according to the BCBSA. This included measures such as emergency department utilization, Sullivan says, and was informed by quality and cost information from the BCBSA's new, large-scale database, Axis.

The Blues announcement comes as both public and private payers are increasingly shifting to value-based payment models. The federal government announced this past January that it will tie 30 percent of all Medicare payments to alternative payment models by 2016 and 50 percent by 2018. And the commercial sector has followed suit--Aetna, for example, says 30.6 of its total spending is now tied to value-based contracts.

To learn more:
- read the announcement

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