Blue Cross advances efforts to transform care delivery, including support for physicians

For nearly 20 years, Blue Cross Blue Shield of Michigan has worked closely with health care providers to make meaningful improvements in the quality and affordability of care.

We’ve done this through such innovative initiatives as the Physician Group Incentive Program, Patient-Centered Medical Home, Collaborative Quality Initiatives and Blueprint for Affordability — all of which provide reimbursement models that reward quality and outcomes.

Despite the many successes of our joint efforts with health care partners, we recognize that we need to do even more to ensure our members get the personalized care they need — in the right setting at the right time, at the right cost. We believe value-based care models will best enable these goals and recognize we need to do more to support physicians and help them be successful in these types of arrangements.

“While the health care industry continues to experience rapid change, health plans and providers are increasingly accountable for member outcomes, cost of care and the overall experience,” said Daniel J. Loepp, Blue Cross president and CEO. “Blue Cross is addressing these expectations through stronger partnerships with our providers and working more proactively and directly with our members.”

We’re helping to meet these needs by further advancing value-based care models and transforming the way care is delivered to members. And we’re evaluating opportunities that:

• Build on our existing foundation of value-based programs.
• Offer new solutions to meet the needs of specific segments of the population.
• Partner with providers to deliver the support they need to be successful in value-based reimbursement programs.

New solutions
We began implementing several elements of this strategy last year. Here are three examples of our efforts to develop, deploy and manage new targeted solutions to meet the needs of providers and specific segments of the population:

• Helping to reduce the administrative burden of health care providers to enable success in value-based arrangements — We announced the acquisition of a management services organization in August. The MSO works with specialists to deploy clinical pathway tools and practice transformation efforts to ensure success in value-based care payment models. In addition, they offer practice management solutions, billing and payment services, and care management tools that help practices track and monitor patients’ health and coordinate their care, allowing physicians and their staffs more time to spend on patient care.
• Assisting members who need integrated, in-home care — We joined forces with Landmark Health to launch a high-intensity, in-home care program for members with multiple chronic conditions. The program offers care management, behavioral health care, medication management, 24/7 nurse triage and urgent care services to complement office-based primary care.
• Ensuring care for residents who live in underserved areas — We partnered with Dedicated Senior Medical Centers, a subsidiary of ChenMed, to establish six new primary care centers in underserved areas of Metro Detroit. The clinics will provide health care for moderate- to low-income seniors who have complex chronic conditions.

“Using deep understanding of member needs, we’ve identified areas where opportunities to offer new care models exist,” said James Grant, M.D., Blue Cross senior vice president and chief medical officer. “Now we’re developing partnerships and programs that offer defined patient populations more targeted care. This should result in better overall health for our members and reduced costs for our customers.”

He added that Blue Cross is committed to offering physicians and their staffs the tools they need to:

• Identify and close gaps in care.
• Coordinate care across the health care spectrum.
• Support practice transformation for success in value-based care models.

Market demands
All these efforts allow us to stay ahead of shifting demands in the market as we develop and offer solutions that reflect customer and member preferences, such as:

• A continued push for evolved value-based care models
• A shift in member preferences toward more convenient, cost-effective sites

“Blue Cross is well-positioned within the industry to facilitate improvements in care delivery and payment models,” said Todd Van Tol, Blue Cross executive vice president, Health Care Value. “We have comprehensive insight into members’ needs. And our strong foundation of collaboration with health care providers allows us to work together to implement new strategies and partnerships efficiently.”

Additional partnerships and programs will launch later this year, and the care delivery strategy will evolve over time in relation to the shifting needs of our members and customers.

“This is a long-term strategy,” Van Tol added. “We’ll continually work to understand member needs and monitor market conditions so we can provide care delivery models to support our population.”

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.