BCBSA Announces Its Value-Based Care Program Outperforms Other Care Providers

Since the launch of the Blue Distinction Total Care program, it has outperformed 96% of industry quality measures in key healthcare quality and patient health metrics, The Blue Cross Blue Shield Association (BCBSA) announced.

Total Care, a national network of value-based care programs, is aiming to improve healthcare and make it more affordable through data sharing to more effectively coordinate, manage, and monitor patient care. Additionally, Total Care aims to shift reimbursement models that put an emphasis on quality instead of quantity of medical services provided, according to the press release.

“Blue Cross and Blue Shield [BCBS] companies created Total Care to bring the most effective, locally developed programs to a national level to better serve the needs of our members and employers,” Kari Hedges, senior vice president, commercial markets and enterprise data solutions for BCBSA, said in a statement.

Since launching in 2015, the Total Care program has demonstrated improvements in the management of chronic conditions, including diabetes, asthma, and cardiovascular disease. Total Care measures are aligned with the accountable care organization and patient-centered medical home core quality measure set established by America’s Health Insurance Plans and CMS.

There has also been an increase in preventive medicine, such as pediatric health screenings and immunizations. According to BCBSA, Total Care doctors, hospitals, and clinical teams are performing better than non-Total Care providers in 96% of the nationally-consistent, industry quality measures.

Specifically, the quality results that reduce medical costs include:

• 10% fewer emergency department visits
• 7% better HbA1c testing for diabetes patients
• 5% better adherence to medications for cardiovascular disease patients
• 15% decrease in hospitalizations year-over-year

There has also been a 35% national decrease in cost from Total Care providers compared to non-Total Care providers, according to measurements through Blue Cross Blue Shield Axis, a data repository compiling provider records from all Blue companies. BCBS suggested that through focusing on wellness, disease management, and better coordinated care, the Total Care program is limiting the costs by keeping patients healthier and out of the hospital.

“The very best healthcare is patient-centered with a continuum of care that fully engages clinical services from a variety of clinicians and clinical services,” concluded Mark DeRubeis, CEO of Premier Medical Associates, the largest multispecialty physician practice in the Greater Pittsburgh area. “Working with Highmark Blue Cross Blue Shield and Total Care, we are empowered to focus on delivering efficient, high-quality care which drives down healthcare costs and improves patient outcomes.”