BCBS Value-Based Care Programs Boost Quality, Reduce Costs

Blue Cross Blue Shield Association’s value-based care programs are outperforming other providers in 96 percent of quality and cost measures.

By Jessica Kent on

The Blue Cross Blue Shield Association (BCBSA) recently announced that its network of value-based care programs, including accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), is outperforming other initiatives in 96 percent of care and cost quality metrics.

The Blue Distinction Total Care Program is the healthcare industry’s largest national network of value-based care programs. Overall, Total Care doctors, hospitals, and clinical care teams are outperforming other healthcare providers in 22 of 23 nationally-recognized industry quality measures.

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Members of the program have produced a 10 percent reduction in emergency room visits and a 15 percent decrease in hospitalizations year-over-year.

Total Care has also demonstrated measurable improvements in the areas of chronic disease management: the program saw a seven percent improvement in HbA1c testing for patients with diabetes, and a five percent rise in medication adherence among patients with cardiovascular disease.  

Nationally, Total Care decreased cost trends by 35 percent compared to non-Total Care providers.

"Blue Cross and Blue Shield companies created Total Care to bring the most effective, locally developed programs to a national level to better serve the needs of our members and employers," says Kari Hedges, senior vice president, commercial markets and enterprise data solutions for BCBSA.

"BCBS companies' local value-based care programs collectively build strong partnerships with doctors, nurses and hospitals that result in measurable health care improvements that help our members receive the right care in the right setting at the right time, while making health care more affordable."

Launched in 2015, Total Care is working to reduce healthcare costs though data sharing to manage and monitor patient care more effectively. The program aims to shift to care reimbursement models that focus on quality instead of quantity.

Total Care includes one-third of BCBS network doctors and hospitals. Since its launch a few years ago, Total Care has seen a 50 percent increase in patients, with more than 19 million BCBS members now receiving care through the program.

Total Care is part of BCBSA’s collection of value-based care programs. Nearly 62 million BCBS members currently have access to care through these programs across all 50 states and Washington, DC.

BCBS expects that Total Care will only continue to grow, with more patients receiving quality, cost-efficient care, and more providers working to improve health outcomes.

"The very best health care is patient-centered with a continuum of care that fully engages clinical services from a variety of clinicians and clinical services," said Mark DeRubeis, CEO of Premier Medical Associates, the largest multi-specialty physician practice in the Greater Pittsburgh area.

"Working with Highmark Blue Cross Blue Shield and Total Care, we are empowered to focus on delivering efficient, high-quality care which drives down health care costs and improves patient outcomes."

Tagged Care QualityHealthcare CostsPatient OutcomesValue Based CareValue Based Reimbursement

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