Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs) partnering with Blue Cross and Blue Shield of Nebraska (BCBSNE) in the company’s Total Care program drove improved patient health outcomes while lowering the cost of care during the 2020-2021 program year, achieving savings of approximately $75.5 million.
Total Care value-based programs are intended to help ensure patients see primary care providers who know their entire medical history, understand their preferences and effectively coordinate optimal care in collaboration with specialized practitioners. BCBSNE members connected (or “attributed”) to a Total Care physician are more likely to be engaged with their doctors, avoid inpatient hospital stays or emergency room visits, get preventive care and effectively manage chronic conditions.
“Fostering strong relationships between physicians and patients is the key to mitigating escalating health care costs,” said Dr. Debra Esser, BCBSNE’s chief medical officer. “Our ACO and PCMH partners want to provide this kind of team-based care for their patients because it is improving health outcomes. When we focus on engagement and prevention, there are more opportunities to help members of all ages get recommended immunizations, manage or reverse diabetes, find cancer in its early stages when it’s less expensive to treat, avoid trips to the emergency room, optimize medication regimens, etc.”
Appreciating the impact these incremental outcomes have on population health, Total Care providers are incentivized by BCBSNE for the quality of care they deliver rather than the volume of services they perform.
The annual health care costs for BCBSNE members attributed to ACO providers in the 2020-21 program year were $636 lower on average than those of members who were not in a Total Care arrangement (saving approximately $53 per month).
“These encouraging results demonstrate what is possible when payers and providers work closely together and hold each other accountable for improving health outcomes, lowering the costs of care and strengthening the system,” Dr. Esser said.
The Total Care quality criteria ACOs are required to meet is established by Health Effectiveness Data and Information Set (HEDIS®) and measured against national benchmarks provided by the National Committee for Quality Assurance (NCQA). Metrics address hospital readmissions, ambulatory care, cancer screenings, immunizations, diabetic care, antibiotic avoidance, medication monitoring and more.
From July 2020 through June 2021, members seeing a Total Care provider were 26% more likely to be screened for colorectal cancer than those not attributed to Total Care. Screening rates were 22% higher for breast cancer and 19% higher for cervical cancer, as well.
Diabetic members attributed to Total Care were 39% more likely to have their blood glucose levels under control, 21% more likely to receive a recommended eye exam and 16% more likely to have a kidney health evaluation than other diabetic members.
More children and adolescents attributed to a pediatric Total Care provider had their well-child visits than non-attributed members in their first 15 months (20% more), between 15-30 months (25% more) and between 3-21 years (37% more). These youth were also 18% more likely to receive all recommended immunizations by age 2, and 17% more likely to receive those recommended by age 13.
“These preventive measures are especially noteworthy in this past program year when many patients were inclined to delay care due to the COVID-19 pandemic,” Dr. Esser said.
About Blue Cross and Blue Shield of Nebraska
Through births and broken bones, tests and treatments, trauma and triumphs, BCBSNE is there with you. Since 1939, we have ensured coverage for the care you need, access to the providers you trust and support from a team that’s right here in Nebraska. As an independent licensee of the Blue Cross and Blue Shield Association, BCBSNE represents the nation’s most experienced health insurance brands that collectively cover one in three Americans. Learn more about BCBSNE and Total Care at NebraskaBlue.com/TotalCare.