Blue Distinction Total Care available for all PPO members in 2017

As introduced in the July 2015 issue of Edge, Independence, and the Blues nationally, are leading the transformation to value-based care with the Blue Distinction Total Care (BDTC) program. The Blue Distinction Total Care (BDTC) program is the culmination of years of effort across Blue Cross and Blue Shield plans. As we approach the full implementation on January 1, 2017, we want to remind you of some key points and share resources you can use to keep the conversation going with your customers.

What is BDTC?

Blue Distinction Total Care combines Blue Cross Blue Shield programs across the country to deliver a national solution for managing health care costs and quality. BCBS Plans partner locally with providers to build programs that best support the needs of each community.

Currently, there are nearly 450 BDTC programs with more than 118,000 providers available across 40 states. These numbers continue to grow as BDTC expands. BDTC is demonstrating results– by reducing hospital admissions, lowering the rate of readmissions, and better controlling chronic conditions. And it’s producing an average savings for employers of $6-9 per attributed member per month (PaMPM).

How does BDTC help Independence customers and their employees?

BDTC supports the Blues ongoing efforts to transition the way health care is delivered. Key to this transition is the shift from fee-for-service provider increases to a fee-for-value model. Independence Blue Cross is committed to this transition and has long been a proponent of value-based care delivery, beginning with our Quality Incentive Payment System (QIPS) program in1992. Independence expanded QIPS effective January 1, 2016 to include all local commercial PPO patients and national BlueCard PPO members. PPO QIPS is Independence’s designated BDTC program.

Beginning January 1, 2017, all Independence customers will participate in national BDTC programs and out-of-state employees of Independence customers will begin to be attributed* to BDTC programs in their geography.

*Attribution is the methodology of how members are assigned to providers based on historical utilization. Attribution is foundational to measuring provider performance and pay for value reimbursements. Attribution methodology may vary by geography (because BDTC programs are designed to reflect local provider dynamics) but are generally claim based.

As we enter 2017, self-funded customers will be invoiced on a per attributed member per month basis for members attributed to national value based programs. Members may be attributed to our local QIPS program or to programs in other states depending on where the member resides and the location of their physician.

What is the timeframe for BDTC?

Here’s a quick look at the BDTC timeline, so you can understand what’s happened so far and what’s coming up.

January 1, 2016

•	All Independence PPO customers participate in PPO QIPS, Independence’s local BDTC program
•	Local PPO¹ members are attributed to Independence primary care physicians based on claims utilization

April 1, 2016

•	Self-funded customers invoiced on a Per attributed Member Per Month (PaMPM) basis for members attributed to PPO QIPS providers (and national BDTC providers for the select customers that piloted the national BDTC program in 2016.)

January 1, 2017

•	All Independence customers will participate in national BDTC programs (out-of-state Independence members will be included for attribution to BDTC programs in their area)
•	Self-funded customers will be invoiced on a Per attributed Member Per Month (PaMPM) basis for members attributed to PPO QIPS and national BDTC programs. Billing for members attributed to national BDTC programs will have a longer lag time to accommodate the transfer of files between Plans (e.g., members in a program in January may be billed in May.)

Resources to help you continue the conversation with your customers

We encourage you to remind your customers about the upcoming implementation of national BDTC programs. There are a number of resources available to help you better understand our programs, as well as resources to use when you meet with your customers.

•	Updated Sales Presentation & speaker’s notes.
•	All Associate Training: Blue Distinction Total Care 2016. To find the training, search by topic name in the Independence University Learning Portal.
•	Blue Distinction Total Care Program in Top Metropolitan Statistical Areas (MSAs). Learn more about the BDTC programs available in the top MSAs.
•	Blue Distinction Total Care site. Learn more about BDTC from the BCBSA website
•	Frequently Asked Questions. Get in-depth answers to your questions about local and national value-based programs.
•	PPO Attribution Report. Available in the Group Portal, the PPO Attribution Report provides a consistent level of detail for members attributed to Independence’s local value-based program as well as out-of-state members attributed to other Blue Plans’ programs.

If you have any questions, please contact MaryBeth Kirschenmann or Lori Donadeo

Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association.