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BCBSA Value-Based Plan Outperforms in Key Health Metrics

By Gregory A. Freeman  
   April 30, 2018

The plan launched three years ago and is showing good results in quality measures.

The Blue Distinction Total Care value-based program is outperforming other care providers in key healthcare quality and patient health metrics since its launch just a few years ago, the Blue Cross Blue Shield Association (BCBSA) announced.

The health plan is the industry's largest national network of value-based care programs, accountable care organizations (ACOs), and patient-centered medical homes (PCMHs). BCBSA says Total Care also is making healthcare better and more affordable through data-sharing that allows it to coordinate, manage, and monitor patient care more effectively.

Total Care was launched in 2015. Since then it has achieved measureable improvements in the management of chronic conditions like diabetes, asthma, and cardiovascular disease.

"In addition, the program is driving a significant increase in preventative medicine, including pediatric health screenings and immunizations," BCBSA reports. "Overall, Total Care doctors, hospitals and clinical care teams are performing better than non-Total Care providers in 96% of the nationally-consistent, industry quality measures tracked."

Total Care also decreased the cost trend by 35% compared to non-Total Care providers, the group reports. BCBSA cites these quality improvements and reductions in cost:

  • 275,000, or 10%, fewer emergency department visits;
  • 7% better HbA1c testing for diabetes patients;
  • 5% better adherence to medications for patients with cardiovascular disease;
  • 15% decline in hospitalizations year-over-year;

"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."

BCBSA says Total Care is part of its shift to patient-focused, value-based care models. Total Care comprises one-third of BCBS network doctors and hospitals, which have shown a commitment to providing better and more coordinated patient care. More than 19 million BCBS members receive care through the Total Care program, a 50% increase since the program launched in 2015.

Gregory A. Freeman is a contributing writer for HealthLeaders.

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