Print“Studies estimate that 30 cents of every healthcare dollar goes to care that is ineffective or redundant. With the nation spending $2.8 trillion on healthcare each year, The Blues believe we must lead in improving care while helping to manage costs.”
Blue Cross and Blue Shield companies across the nation are spending more than $65 billion a year—about one in five medical claim dollars—on value-based care programs that provide incentives for better health outcomes for patients while reducing costly duplication and waste in care delivery.
These programs shift payment away from the fee-for-service model, which rewards the volume of medical services provided, to one that links reimbursement to the quality of care and improved patient outcomes.
Made up of 37 independent community-based and locally operated companies, the “Blues” provide coverage for about one in three Americans, 100 million people. The Blue Cross Blue Shield Association, a trade group, says its members have developed about 350 value-based programs across the country. The companies have engaged with more than 215,000 physicians, including 155,000 primary care physicians and nearly 60,000 specialty physicians, to increase quality and rein in healthcare spending. These value-based programs cover more than 24 million people.
“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,” says Scott Serota, CEO of the Blue Cross Blue Shield Association. “Studies estimate that 30 cents of every healthcare dollar goes to care that is ineffective or redundant. With the nation spending $2.8 trillion on healthcare each year, The Blues believe we must lead in improving care while helping to manage costs.”
The Blue System portfolio includes accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs, all aimed at rewarding quality care and improving outcomes for patients.
Blue companies around the country report reductions in emergency room visits, hospital admissions and readmissions and other costly medical interventions. At the same time, there have been measurable improvements in prevention, including better diabetes control and higher rates of screenings and immunizations. Initial reports show savings of $500 million in 2012.
The programs encourage and support clinicians and hospitals in modernizing their practices and coordinating their patients’ care. They also help consumers engage in making the best decisions for their own health through wellness programs, information that helps them manage chronic conditions and resources that help them fully understand the quality and cost of medical services.
July 14, 2014
http://www.burrillreport.com/article-blue_cross_moves_toward_value_based_healthcare.html
