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Blue Cross: Value-based care delivers huge ROI


The Blue Cross Blue Shield Association's plans are spending more than $65 million a year in value-based payment programs that have a high return on investment. In 2012 alone, the plans saved $500 million.

Blue Cross plans administer more than 350 value-based programs ranging from accountable care organizations and patient-centered medical homes to pay-for-performance and episode-based payments in 49 states, according to a new BCBSA report.

The result has been a widespread reduction in emergency room visits, hospital admissions and readmissions. Moreover, Blue Cross plans have seen improvements in preventive care, including better diabetes control and an increase in screenings and immunizations.

"Through these innovative, value-based care models, Blue Cross and Blue Shield companies provide patients with access to improved care while also creating value for our members, employers and taxpayers supporting public healthcare programs," BCBSA CEO Scott Serota said yesterday in a statement.

The three keys to its success include:

  • changing payment incentives and reimbursements to reward providers when they offer value and quality care;
  • partnering with clinicians to provide necessary support, data and tools so they can implement quality care; and
  • engaging patients with wellness programs and transparency tools, plus educating them about how to be more healthful and manage chronic conditions.

Serota added that all the Blue Cross programs are based on the unique needs of local markets. "Healthcare is provided locally, and each community has distinct health challenges," he said. Therefore, this isn't a single, silver bullet approach that insurers can take to incentivize value-based care.

BCBSA isn't alone in beefing up value-based payment programs. These arrangements are quickly becoming the norm for payers and providers: WellPoint has more than 100 ACO-type organizations, and UnitedHealth's accountable care contracts total $30 billion, FierceHealthPayer previously reported.

To learn more:
- read the BCBSA statement and report (.pdf)

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