BC/BS Leaders Share Ideas

A Capitol Hill briefing presented by the NIHCM Foundation www.nihcm.org to discuss “Transforming Health Care to Drive Value” was held October 27, 2017. The briefing featured two CEOs from state Blue Cross Blue Shield organizations sharing their insights on how their organizations are working to improve health outcomes while still managing the cost of care.

“I think we’re approaching a watershed moment on health spending,” said Nancy Chockley, President and CEO, NIHCM Foundation. Healthcare costs have become a heavy burden for individuals and society, but there is a growing body of evidence on what works and what doesn’t work to control costs.

Curtis Barnett, President, Arkansas Blue Cross and Blue Shield www.arkansasbluecross.com  told the attendees, “We’ve found that private companies and public agencies involved in healthcare financing have a somewhat common vision to make quality healthcare more accessible and affordable for the consumer.

To move forward, Arkansas Blue Cross and Blue Shield announced that seven practices were going to participate in a Patient Centered Medical Home (PCMH) pilot program. This initiative focuses on using a team approach requiring EHRs to be used. This is to ensure that complete health and medical information is given for each patient and greatly encourages patient and caregiver engagement

The PCMH program rewards providers who meet definite metrics for care coordination and general practice investment. By paying for patient results and outcomes instead of services, Arkansas Medicaid is able to control costs and at the same time, improve quality of care.

SAMA Healthcare http://samahealthcare.com, a PCMH practice in South Arkansas, has redesigned their practice and is using mobile technology. They have hired nurse practitioners and care managers, and have shifted away from fee-for-service. The result is that they have lowered total costs of care and achieved higher levels of quality.

Arkansas statewide has taken part in the CMS program called the “Comprehensive Primary Care Classic” https://innovation.cms.gov with 230 providers taking part. The initiative is a multi-payer initiative fostering collaboration between public and private healthcare payers to strengthen primary care. So far, patient satisfaction is up, hospital readmissions have been reduced, quality has improved, and savings have resulted.

The state is also taking part in the CMS Comprehensive Primary Care Plus (CPC+) program with 689 providers which is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payment reform and care delivery transformation.

The Blue & You Foundation www.blueandyoufoundationarkansas.org funded by Arkansas Blue Cross, awards grants to nonprofit or government organizations for projects that deal with healthcare delivery, policy, and economics. So far, the foundation has awarded more than $27 million in health improvement grants.

David W. Anderson President and CEO Blue Cross Blue Shield of Western New York https://www.bcbwny.com and Blue Shield of Northeastern New York https://bsneny.com, headquartered in Buffalo, discussed how difficult it is to provide healthcare in some parts of New York state, since a number of local practices in rural areas are closing or consolidating due to an aging primary care workforce.

Last January, BC/BS in Western N.Y. launched “BestPractices”, which is a new payment approach geared for use by primary care doctors. BestPractices compensates doctors through a reimbursement model that rewards quality and efficiency in managing members’ health.

BestPractices provides doctors with consistent, predictable monthly payments based on their patient panels, regardless of whether services are provided to all or just some patients in any given month.

Also, preventive care, as recommended by national professional bodies still continues to be paid on a fee-for-service basis. For all other services, doctors are paid a capitation payment which is a set amount for each BC/BS patient assigned to them each month whether or not that person seeks medical care that month.

This is called a ‘Per-Member, Per-Month” (PMPM) payment. For each primary care doctor’s base, the PMPM rate is calculated based on historical claims paid by BC/BS to the doctor, In 2018, an adjustment will be added for each doctor’s relative efficiency or how well the doctors use available resources to manage the total cost of their patients” care.

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