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Value-Based Care Program Shows Measurable Results


A network of value-based care programs from the Blue Cross Blue Shield Association emphasizes quality instead of quantity of medical services provided.

Strong data-sharing partnerships with hospitals, doctors, and nurses can effectively coordinate patient care and achieve better outcomes, show the results from one program.

Blue Cross Blue Shield (BCBS) companies' Blue Distinction Total Care (Total Care) program, a network of value-based care programs-accountable care organizations and patient-centered medical homes-is making healthcare better and more affordable through data sharing to more effectively coordinate, manage, and monitor patient care and by shifting to reimbursement models that put an emphasis on quality instead of quantity of medical services provided.

Specifically, Total Care resulted in measureable healthcare improvements in the management of chronic conditions like diabetes, asthma, and cardiovascular disease, and is driving a significant increase in preventative medicine. Nationally, Total Care is also resulting in a 35% decline in the growth of medical costs from doctors and hospitals who are participating in the program, according to Kari Hedges, senior vice president, Commercial Markets & Enterprise Data Solutions, at the BCBS companies.

Total Care cost trend of approximately 5% is less than the national average of 6.2% reported by PricewaterhouseCoopers, for the same time span.

“Value-based care programs-done well-can improve the quality of care patients receive while driving down the cost of care,” Hedges says. “Through strong partnerships with doctors, hospitals and nurses, we are helping our members receive the right care in the right setting at the right time, while making healthcare more affordable.”

Launched in 2015, the Total Care program is driving a significant increase in preventative medicine, including pediatric health screenings and immunizations. 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. Quality results that reduce medical costs include:
• 275,000, or 10%, fewer emergency department visits
• 7% improvement in HbA1c testing for diabetics
• 5% better adherence to medications for cardiovascular disease patients
• 15% decline in inpatient hospitalizations year-over-year

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