July 22, 2014
BATON ROUGE, La. – As the health insurance industry increasingly rewards providers for delivering higher value care, the industry is naturally shifting from the traditional fee-for-service model, which rewards volume and can be duplicative or medically unnecessary, toward care that adds value and is cost effective.
That is the principle behind Blue Cross and Blue Shield of Louisiana’s Quality Blue family of programs. In these programs, Blue Cross collaborates with providers in its networks to bring value by improving patients’ health outcomes and keeping healthcare costs in line.
Building on the success of existing Quality Blue programs, most notably Quality Blue Primary Care, Blue Cross is rolling out a new program to continue the transformation to value-based care.
Quality Blue Value Partnerships launches this month, with five large provider systems currently enrolled: Baton Rouge Clinic, Baton Rouge General Physicians Group, Gulf States Quality Network, Ochsner Health System and West Calcasieu Virtual Medical Home.
“Blue Cross, a long-time leader in developing solutions to improve healthcare in Louisiana, is driving the needed transition to value-based care with our Quality Blue programs,” said Dr. David Carmouche, Blue Cross and Blue Shield of Louisiana Executive Vice President for External Operations and Chief Medical Officer. “Our latest effort, Quality Blue Value Partnerships, is a perfect example of how we can provide the data and analytical resources that traditionally have not been available to doctors and clinics. Using these resources, we can break down silos to gain a full picture of what’s going on. We can more easily work with these professionals to meet shared goals for our mutual customers – our members, their patients.”
Quality Blue Value Partnerships best serves large provider groups that have an array of doctors within the same healthcare system. To participate in Quality Blue Value Partnerships, doctors must already be enrolled in Quality Blue Primary Care, the population health management program Blue Cross introduced last year.
Quality Blue Primary Care focuses on effectively coordinating patients’ care with Blue Cross clinical staff who work directly with family medicine, internal medicine and general practice physicians. This program especially benefits those who have chronic conditions, allowing doctors to efficiently share information and identify gaps in care.
Blue Cross is the only health insurance company in Louisiana that offers a program like Quality Blue Primary Care, and after one year, nearly 400 primary care physicians are now enrolled, coordinating care for more than 130,000 Blue Cross members.
By adding Quality Blue Value Partnerships, large provider systems can expand beyond primary care and examine their patients’ treatment experiences throughout the entire system, including with specialists, hospitals and outpatient centers that they manage. These types of systems are also called Accountable Care Organizations.
Quality Blue Value Partnerships is an enhancement to an existing Accountable Care Organization program that Blue Cross created with Ochsner Health System and Baton Rouge General Health System.
To provide the technical and analytical support needed for Quality Blue Value Partnerships, Blue Cross is paying for each enrolled system to access the online TREO Solutions dashboard. Using TREO, administrators can review Blue Cross claims data to identify ways that they can better use resources, change their practice patterns, or conduct more robust engagement and outreach activities to give patients the most appropriate level of care in the best setting.
For example, healthcare systems can have doctors prescribe more generic drugs, or they can reduce costly out-of-network services by referring patients to the most cost-efficient provider or to other providers within the same system for lab work or tests. These interventions effectively reduce medically unnecessary services and control costs.
If the healthcare systems enrolled in Quality Blue Value Partnerships demonstrate that they have followed effective cost-saving strategies, Blue Cross will reward them by paying a percentage of the savings they achieved. The first five providers officially began in new Quality Blue Value Partnerships on July 1, and in late 2015, they will have their first opportunity to receive a payment through the program.
For more information about the Blue Cross Quality Blue programs, go to http://www.bcbsla.com/Providers/Pages/QualityBlue.aspx.
About Blue Cross and Blue Shield of Louisiana
Founded in New Orleans in 1934, Blue Cross and Blue Shield of Louisiana is a private, fully taxed mutual company, owned by policyholders—not shareholders. It is an independent licensee of the Blue Cross and Blue Shield Association and is governed by a Louisiana Board of Directors.
The company and its subsidiaries provide group and individual health insurance plans, life and disability insurance, group voluntary products and administrative services to Louisiana residents. With headquarters in Baton Rouge and eight district offices around the state, Blue Cross and Blue Shield of Louisiana is committed to improving the lives of its customers by providing them with health guidance and affordable access to quality care.
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