BATON ROUGE, La. – Blue Cross and Blue Shield of Louisiana and the 23 network Accountable Care Organizations enrolled in the insurer’s Quality Blue Value Partnerships program said they got better health results for patients while holding down total healthcare costs over the past year.
In this program, ACOs – physician groups that deliver primary care, specialty care and other healthcare services – that successfully improve health outcomes in ways that lead to lower costs earn incentive payments equal to a percentage of their savings.
Typically, Blue Cross issues these shared-savings payments in the summer. But, because of the COVID-19 stay-at-home order earlier this year, many of the enrolled providers couldn’t see patients or deliver care as usual. To minimize the pandemic’s effect on clinics and give them revenue to keep operations going until routine care could resume, Blue Cross issued the payments in April.
“We work closely with our provider partners to support them in doing what they do best – treating their patients,” said David Hochheiser, Blue Cross senior vice president of Provider Networks and Healthcare Value. “That was especially important as we faced an unprecedented health crisis this year, and we were pleased that we could help providers keep their clinics going and focus on the immediate threat of the pandemic. We want to help our providers be successful because when they are, our members – their patients – have improved health and lives. And that is the ultimate goal of Quality Blue.”
The most recent program year’s results show the enrolled ACOs saved an average 2.4% on their total costs of healthcare, with the most successful savings reaching 13%. This is the fifth year in a row Quality Blue ACOs have gotten such results, which mainly stem from healthcare providers taking steps to prevent unnecessary emergency room visits and keep patients out of the hospital.
To help the ACOs coordinate care and drive savings, Blue Cross gave the ACOs training, tools, and support – including hands-on help from Blue Cross’ own staff –to identify ways they could use services more efficiently. Blue Cross’ analytics and data team also worked closely with the ACOs to share health data and overall cost information securely, which helps providers identify their patients most in need of care interventions.
Blue Cross uses in-house predictive analytics models to show ACOs which of their patients are most at risk of hospital admissions, emergency department visits and other intense, high-cost treatment needs so the patient’s healthcare providers can respond quickly.
Using these data-driven insights, Blue Cross and the ACOs work together to identify which interventions would do the most good and use resources more effectively. For example, some of the successful strategies ACOs implemented are:
- Delivering comprehensive primary care, so patients could have most of their health needs treated in a primary care provider’s office rather than an emergency room, hospital or urgent care. Primary care providers also coordinated referrals to specialists when needed, to help patients stay in their networks for care.
- Enrolling eligible patients in Blue Cross’ Care Management programs, which support patients in being STRONGER THAN any disease or diagnosis. Patients can get free health coaching, education about when it is appropriate to go to the emergency room and self-care tips to stick to their treatment plans and stay on top of chronic conditions.
- Referring patients to the most cost-effective locations when they needed outpatient services and tests like lab work, imaging, mammograms or colonoscopies.
- Prescribing lower-cost, clinically effective drugs, including more generics when appropriate.
The Quality Blue programs, which Blue Cross launched in 2013, let providers earn value-based payments by meeting specified health outcome measures that improve care quality. This holds the line on total costs of care, particularly for patients who have chronic conditions like diabetes, heart disease or high blood pressure.
To learn more about the Quality Blue programs and how they help members, visit www.bcbsla.com/MyQBPC.
