BCBS Links $71B to Value-based Care

Various patient-centered and value-based programs have also generated about $1 billion in savings in 2013 by reducing costly and wasteful care duplication, according to the Blue Cross Blue Shield Association.

The nation's Blue Cross and Blue Shield plans saw $71 billion in spending directed toward patient-centered, value-based care in 2013, according to an in-house survey released this week.

That $71 billion represents about one-in-five dollars in medical spending in 2013 by the 37 BCBS companies across the nation, an increase of 9% over the $65 billion in value-based care the plans identified in 2012.

The various patient-centered and value-based programs also generated about $1 billion in savings in 2013 by reducing costly and wasteful care duplication, according to the Blue Cross Blue Shield Association, which compiled the survey.

"It's only going to go up," says Justine Handelman, vice president, legislative and regulatory policy, at BCBSA. "We are really trying to push the move away from fee for service in how we incentivize quality over quantity. This report really illustrates how we've been able to hone in on what's been working and how we can work with public payers and the government to reform the healthcare system."

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Handelman says the Blue Cross plans have keyed on four strategies to shift away from fee-for-service, which she identified as:

• Changing how providers are paid to include incentives for delivering better care.
• Providing doctors and hospitals with tools and real-time patient data to transform their practices.
• Helping consumers to become active in their healthcare.
• Promoting savings by reducing duplicative or unnecessary services and tests.

"Our goal is to continue to raise the bar and move in the direction and as we learn what's working to make sure that we are adapting our system to provide the best quality care and ensure we have the best outcomes for people," Handelman says.

The 2013 survey identified 570 locally-developed, patient-centered care programs in 48 states, Washington D.C. and Puerto Rico, up from 350 such programs in 2012. Combined, the Blues contract with more than 228,000 physicians and 1,500 hospitals to expand value based care. More than 25 million BCBS customers are enrolled in some sort of value-based plan that include accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs.

"The acceleration is tremendous," Handelman says. "We've got more than one-in-five medical claims dollars. That is growing. We are excited that the government is moving in the direction of working to align with what is already working in the private sector. We have the results and the acceleration as you see Medicare coming online with what we are already doing and what is working. We will see it accelerate even more."

"In five years we are really going to see a transformed delivery system with the Blues leading the way," Handelman says. "The way we are using data and technology is really going to explode over the coming years. We are going to be in a truly value-based system."

See Also:
The Two Biggest Mistakes Hospital and Health System CEOs Are Making
Medicare's Value-based Care Payments Gaining Momentum