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The Exec: Bolstering Value-Based Primary Care with Blue Cross' Ashley Yeats

Analysis  |  By Jay Asser  
   May 25, 2023

The vice president of medical operations speaks on the health plan's addition of three physician groups participating in its value-based payment program.

Blue Cross Blue Shield of Massachusetts (BCBSMA) is taking steps to boost access to both value-based care and virtual care.

The payer announced the expansion of its primary care network with three new physician groups—Eden Health, On Belay Health Solutions, and VillageMD—which will participate in its value-based payment program and offer members virtual and in-person services, such as telehealth, chronic disease care, mental health support, and carve navigation support.

On the heels of the expansion, BCBSMA also announced Tufts Medicine will becomes the fifth health system to take part in the health plan's equity-focused value-based agreement, with a focus on reducing inequities in colorectal cancer screenings, hypertension, diabetes care, and child and adolescent well-care visits.

The moves highlight BCBSMA's initiative to continue pushing the ball down the field on primary care, said vice president of medical operations Ashley Yeats.

Yeats spoke with HealthLeaders on the impact of the payer expanding its network, how it furthers value-based care and virtual care, and where both currently stand coming out of the pandemic and heading into the future.

This transcript has been edited for clarity and brevity.

HealthLeaders: What was the impetus behind the expansion to add three physician groups?

Yeats: We believe that primary care is essential and at the core of care delivery. In fact, care that's coordinated by primary care physicians leads to better health outcomes. Having a primary care physician enables patients to feel more empowered and take control of their health. They are more likely to get their preventive health screenings, for example, than if they didn't have a primary care physician. However, there's still a real access issue.  

Coming out the pandemic, two big opportunities surfaced. One was an acceptance around virtual care and telehealth and how much more patient-centered these can be for people that maybe don't access to in-person primary care. The pandemic also emphasized the need for more mental health services and support.  

This seemed like both an opportunity and a natural alignment with Blue Cross' commitment of expanding its primary care network with practices that are transforming care and supporting value-based care through the AQC [Alternative Quality Contract].

HL: Where does the physician shortage factor into the motivation and how does that affect payers like Blue Cross?

Yeats: I don't want to suggest that adding three providers solves the primary care shortage. The acceptance, maturation, and investments that have been made in virtual primary care has enabled greater access across the US that just didn't exist prior to the pandemic. Telehealth has the ability to alleviate some of the impacts of the primary care physician shortage.

Through the use of virtual care, we can improve access and help members get the care they need.

HL: Speaking of virtual care, that seemed to peak during the early stages of the pandemic, but now that the pandemic is more in the rearview mirror, where do you see utilization of virtual care going?

Yeats: Virtual care was a necessity during the pandemic—and it still is. Virtual care has yet to find its equilibrium, but it's getting there. Where it lands is going to depend on the specialty - obviously, some specialties are much more amenable to that kind of care delivery model. Mental health comes to mind—I think we'll see care delivery in that area continue to grow.

I'm interested in seeing what the next few years brings in how virtual care may lend itself to better outcomes than what we've seen to date in chronic disease management. Virtual care is here to stay, and we need to learn and support the potential for innovation. 

HL: What does the current value-based care landscape look like and what more needs to be done to achieve full adoption?

Yeats: We pioneered this path in 2008 with our AQC contracts. We were thrilled to be able to leverage that opportunity in small group value-based care contracting that came out of some work in conversations that started in 2017. We stand behind this concept of paying for outcomes and quality and not paying for volume. It's a long road and it requires commitments on all sides (policy-makers, payers, providers, and patients) to ensure that we continue to work toward a more affordable, equitable healthcare system.

The pandemic also emphasized many of the racial and ethnic inequities in care that are prevalent. Part of our vision for the evolution of value-based care is working payment for equity and outcomes into our contracts and hopefully inspiring others to take action.

I believe we're taking the necessary steps to continue to inch forward on this and hopefully drive larger change and adoption on a national scale.

Jay Asser is the contributing editor for strategy at HealthLeaders. 


KEY TAKEAWAYS

In two separate moves, Blue Cross Blue Shield of Massachusetts recently expanded its physician network and added a health system to its pay-for-equity payment model.

President of medical operations Ashley Yeats spoke with HealthLeaders about the payer's motivation to increase access to value-based primary care.


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