BCBS Rolls Out 'Total Care' National Network

When it's operational on Jan. 1, 2016, Total Care will allow employees of large companies to access nearly 450 patient-focused care programs from 36 BCBS independent companies operating in 37 states.

The Blue Cross Blue Shield Association Tuesday announced the creation of Blue Distinction Total Care, a value-based national care network designed for large businesses with employees located in many different states.

When it's operational on Jan. 1, 2016, Total Care will allow employees of large companies to access nearly 450 patient-focused care programs from 36 BCBS independent companies operating in 37 states. The network includes more than 59,000 primary care professionals and nearly 59,000 specialty clinicians, with network growth expected to continue to in the coming years, BCBSA said.

Nearly 13 million BCBS enrollees already access Total Care in various local markets and this number is expected to grow as more employees of large multi-state businesses participate, said Maureen Sullivan, chief strategy officer for BCBSA, speaking by phone Monday.

"What's new is that national employers can now access it across markets," she says. "There is about $145 billion in spending going on now through value-based programs, so they are a significant part of the landscape, but until now national businesses with employees across the country could access this only by market-by-market. Now they have a national solution. This is a pioneering approach that provides a national network to that local market innovation."

The Total Care estimated savings range is between $6 and $9 per employee per month, or more than $840 million over traditional payment models on an annual basis, BCBSA said.

For Total Care to work, employers need to save money and their employees need to find value in the care. "Our criteria are built around those two outcomes," Sullivan says. The sales pitch to larger employers is that "for the first time you are going to have access to a national program that is patient focused that will provide more integrated care for greater savings and better long-term results. We think the employees are going to find it of greater value."

Sullivan says Total Care "will be monitored on an ongoing basis" to determine whether or not it's on track by the first or second quarter of next year. "If not, we will work with our local Blue Cross Blue Shield plans to adjust. We don't have a specific threshold for enrollment, but we want to see that it is growing."

The various local markets for Total Care plans have already showed savings through reductions in emergency department visits and reduced hospital admissions and readmissions.

Sullivan says the plans have demonstrated improvements in cholesterol and diabetes control, and higher screening and immunization rates. "Many of these started around a certain chronic condition. It's when you are in need of that integrated care that the gaps in our delivery system become most acute. That said, it's helpful for all of to have an integrated health system, but this has been built for people with chronic health conditions."

If Total Care takes off, BCBSA says there are plenty of resources for expansion with 700 locally designed, patient-focused programs in 49 states and Washington DC that include nearly 327,000 clinicians and 2,000 hospitals. BSBS plans now provide coverage for more than 42 million enrollees.