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| July 22, 2015 |
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Blue Distinction® Total Care: Local Health Care with a National Reach Despite having the most expensive health care system in the world, Americans' health compares poorly with the health of people in many other countries. Too much of this money is not well-spent — by some estimates, 30 cents of every health care dollar goes to care that is ineffective or redundant.* Evidence clearly shows that more care does not equal better care. Today's health care system, though rapidly changing, is based largely on a fee-for-service payment methodology in which health care providers are paid for each service performed. This can create incentives for providers to focus on the volume of services rather than the value or quality that they provide. It can also encourage providers to lose sight of the bigger picture: the patient's overall health and coordinating care between visits. Leading the Transition to Value-Based Care By encouraging providers to deliver the right patient care at the right time and place, guiding patient referrals to improve patient outcomes, and reducing costs, Blue Cross and Blue Shield (BCBS) plans have played a pivotal role in changing provider incentives to promote higher-quality, affordable care for all patients. A common industry term for this is value-based care. BCBS plans have long been pioneers of this concept, developing and implementing several different value-based payment models, such as Accountable Care Organizations and Patient-Centered Medical Homes. Given the demonstrated impact of these programs, Blue Distinction Total Care (BDTC) was launched in January 2015 so that national accounts would have access to and could fully experience the advantages of value-based care. The Next Step: Blue Distinction Total Care The objective of BDTC is clear: to help BCBS national account employers improve health outcomes while controlling rising health care costs. This is accomplished by providing employees with access to the largest national value-based network of providers who are contractually accountable for lowering health care costs and improving health outcomes for their assigned, or "attributed," patients. Unmatched in scale and access by any competitor, BDTC already connects more than 9.5 million local members to nearly 400 locally-tailored programs across the country. Each BDTC program is distinctively local and has been tailored to address the unique needs of BCBS members and providers in that community. BDTC identifies physicians and hospitals engaged in value-based delivery models who:
In order to hold providers increasingly accountable for managing care of the whole patient, members must be assigned or attributed to them. Attributing members to BDTC providers also prompts the flow of actionable data-sharing between BCBS Plans and providers. As BDTC programs are designed to reflect the local provider marketplace dynamics, each local plan uses its own attribution methodology; however, there are common themes to these approaches A fairly common methodology uses claims history to identify which provider a member has seen most often and then assigns the member to that provider. Attribution may also be based on targeted medical conditions (employee is attributed based on certain medical conditions such as diabetes or hypertension). When Will Blue Distinction Total Care (BDTC) be implemented? Value-based payments shifts away from today's predominant compensation model under which providers are paid solely based on the volume of services they deliver – without regard to quality or efficiency – to a model where providers are paid based on the value of the services they deliver. In response to clear customer demand that the Blues move in this direction – and based on the positive results seen in pilot programs across the country – paying providers based on the value they deliver is becoming the standard way Blue Plans contract with providers. Blue Distinction Total Care can drive positive change in quality and cost when all of our business participates. Independence will be piloting the BDTC program with select accounts in 2016, and full account participation will be staged on group renewal date in 2017. Stay tuned for additional news and information about BDTC and about a new BDTC primary care value-based program to be launched in the Philadelphia market this fall.
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