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A message from Steve Anderson, vice president, Hospital Contracting and Network Administration Over the past five years, Blue Cross Blue Shield of Michigan has introduced several new care and reimbursement models designed to increase access to care, improve quality, reduce cost and improve care for our members. To get a better understanding of what our objectives are and how we’re doing, we interviewed these Blue Cross experts:
What can you tell us about so-called risk agreements, including Blueprint for Affordability, and what’s their objective? VanPutten: Risk agreements are focused on reducing the overall cost of care delivered while maintaining a high quality of care for our members — your patients. The risk arrangements being designed are focused on offering incentives for health care providers to encourage them to become more engaged in care and cost management, delivering the right care at the right time and in the most appropriate care setting. Billi: We know that the vast majority of our participating health care providers are committed to doing the right thing — that given the right incentives, the right data and the right tools, they’ll provide high-quality, cost-effective care. We operate from the premise that the greater financial accountability they have through risk-based contracting, the more inclined they’ll be to accomplish needed transformation. How many risk-based contracts do we currently have? Billi: On the commercial side, we have 25 contracted entities with Blueprint for Affordability shared-risk contracts. This represents 50% of our attributed membership. Of those, eight are also engaged in full-risk Medicare Advantage PPO arrangements. VanPutten: It’s important to note that there are multiple agreements with various organizations to cover the different lines of business: PPO, Blue Care Network, Medicare Plus Blue℠ PPO and BCN Advantage℠ HMO. For example, in addition to the commercial contracts Andrew mentioned, we have more than 160 risk agreements for BCN Medicare and Medicaid plus about 30 full-risk agreements for Medicare Plus Blue and BCN Advantage. Andreshak: On the hospital side, it works a bit differently. We use value-based contracting, called VBK, arrangements. We have 22 hospital systems, consisting of 76 hospitals, participating in VBK contracts. This represents 84% of our hospital payments. What successes have you seen as the result of our value-based strategy? Burns: We have lowered the cost trend, improved performance on HEDIS® quality measures* and received solid Star Ratings for our Medicare Advantage plans. (See the article on the new Star Ratings video, also in this issue, for more details.) VanPutten: Our Star Ratings are particularly impressive since the Centers for Medicare & Medicaid Services raises the performance thresholds each year, making a 4-Star Rating increasingly difficult to achieve. What challenges do you see in accomplishing our long-term value-based strategy? VanPutten: Risk models are very complicated and getting more complicated over time. We have to ensure that providers don’t lose sight of what they can do to be successful in a value-based arrangement — and that’s a challenge that Blue Cross needs to address. Billi: It’s extremely challenging to beat the cost trend year over year and to find opportunities for improvement that can make a big difference and warrant significant financial investment. We rely on our hospital and physician partners to let us know of areas where we can provide them with necessary support that will enable them to better manage cost while improving quality. Andreshak: One area that I think could help improve performance overall that we are working on is to better align hospital and physician incentives so that VBK on the hospital side more closely mirrors Blueprint for Affordability on the physician side. When hospitals and physicians work more closely together, we can really make a difference in improving the health of our shared population of patients. Many people feel that the U.S. health care system is broken. Do you have any additional thoughts on how we can help fix the problems with health care in the future? Burns: It would help if incentives were aligned among payers, providers (both physicians and hospitals) and both members and employers. We all need to be moving in the same direction, and each initiative needs to be supportive of the other. It’s sometimes easy to forget that members can also play a significant role in lowering health care cost and improving outcomes. Patients need to be compliant with their health care regimen, get regular preventive care and take a more active role in their health management. Billi: On the Blue Cross side, we need to give our providers accurate, timely and actionable data and guidance that can help them identify opportunities for improvement. We also encourage providers to use and analyze their own sources of information. Andreshak: In the area of data and reporting, what I think providers need most from us is benchmarking and analysis — seeing how they compare with their peers so they can determine what they might want to do differently going forward. VanPutten: In short, we need to build an overall strategy so that when you combine all the components together, it delivers value for all stakeholders. If we can create structures that fairly compensate providers at a base level and build meaningful incentive models that provide the opportunity for enhanced revenue when they lower the cost trend and improve quality, we can help drive the change we wish to see. In conclusion To read more about value-based care, including our Blueprint for Affordability program, see this article, also in this issue.
*HEDIS, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance. |
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. |
