BCBSA Says It Can Help U.S. Save $319B by 2021

The Washington, D.C.-based Blue Cross and Blue Shield Association wants to share some how-to knowledge with the federal government to help improve healthcare quality and rein in costs. Citing best practices implemented by many of BCBSA's 39 plans, president and CEO Scott P. Serota said the government should "encourage the private sector to innovate. Let us figure out what works."

He added that the federal government should "learn from our experiences and then communicate those experiences to speed adoption" of the practices.

At a press conference Tuesday, Serota announced a roll-up-your-sleeves action plan that he estimates could produce $319 billion in Medicare and Medicaid savings over the next decade by replicating a number of innovations underway at various Blue Cross and Blue Shield companies across the country.

The plan presents 20 recommendations to improve healthcare quality and tackle rising costs. It focuses on what it says are four actionable steps the government can take: reward safety, do what works, reinforce front-line care, and inspire healthy living.

The plan matches policy steps Blues plans across the country are taking, such as investing in the primary care workforce, coordinating care to better manage chronic conditions,  and designing incentive programs to drive safety, with examples of how the policies are being implemented at Blues plans:

• The foundation at Blue Cross and Blue Shield of North Carolina awarded a $1.2 million grant to increase the number of North Carolina-trained medical students who elect family medicine residency programs and practice in the state.
• In partnership with a major account, Regence Blue Shield developed a patient-centered medical home for highest risk employees—the ones who account for 65% of the company's healthcare costs. The program resulted in a 20% reduction in healthcare costs.
• Highmark Blue Cross Blue Shield's QualityBLUE hospital pay-for-performance program aligns reimbursements with high-quality care and improved outcomes. In 2011 the program results in $48 million in savings.

• Expand value-based payments in Medicare.
• Make care coordination available to all Medicare beneficiaries.
• Ensure that government payment policies recognize the value of primary care.
• Align federal delivery system reform initiatives with private sector best practices to promote primary care.
• Expand government initiatives to reduce healthcare disparities.
• Promote safe deliveries and improve maternal care.

Kenneth Thorpe, PhD, a professor and chair of the department of health policy & management at Emory University in Atlanta, who produced the program's economic analysis, said the BCBSA program stresses proven actions. "I have pilot fatigue. We don't need another pilot where we wait 12 to 15 years for the results. We know what works and we need to do it now."