At BCBSTX our goal is to develop ways to help our contracted providers improve health care and reduce the overall costs of care. Our value-based care models show our evolving steps for balancing quality and affordability:
- Hospital Admissions
- Emergency Room Visits
- Duplicate Services
It connects contracted doctors, hospitals and other providers with the aim of improving health outcomes.
Intensive Medical Home (IMH)
IMH focuses on helping providers deliver hands-on clinical support for chronic or complex health issues. Providers employ a dedicated nurse care manager to assist in coordinating the member’s health care.
Performance-Based Reimbursement Program
This program incentivizes contracted hospitals to reduce:
- Mortality rates
All incentives focus on exceeding quality performance levels.
Blue Distinction Centers for Specialty Care
Blue Distinction Centers for Specialty Care, a Blue Cross and Blue Shield Association (BCBSA) designation, recognizes contracted health care facilities that have a track record of delivering better overall care for certain diseases or treatment, including:
- Bariatric Surgery
- Cardiac Care
- Cellular Immunotherapy
- Fertility Care
- Gene Therapy
- Knee and Hip Replacements
- Spine Surgery
- Substance Use Treatment and Recovery
- Transplant Surgery
Blue Distinction Total Care (BDTC)
BDTC is a national BCBSA designation that recognizes contracted doctors and hospitals for their efforts in coordinating total patient care.
Saving with BCBSTX Value-Based Care
Our cutting-edge contracted provider arrangements work to lower total spending by:
Increasing Accessibility to Patient History
We’ve built tools that pull two years’ worth of claims history data at a time.2 This gives contracted health care providers a clearer picture of treatments their patients have – or haven’t – completed within the two year period.
Tailoring Specialty Care Costs
Group health care benefits programs can be adjusted to help meet cost objectives. For example, employee copays may get lowered when visiting Blue Distinction Centers and Blue Distinction Centers+.
Making Health Care More Accountable
BCBSTX works with contracted providers to create a team-based, primary care approach that aims to offer the right care at the right time.
Measuring Performance Results
We use data to:
- Measure success
- Provide financial incentives to providers
- Drive clinical and quality performance
This helps us toward our goal to increase quality and lower the overall cost of care while helping members stay healthy and productive.
Offer Smarter Care for Better Health.
Contact your BCBSTX account representative with questions on value-based care.
1 Prior results are not a guarantee of any future results and individual results may vary. The programs are tools to assist the independently contracted providers in rendering care to members. The final decision about any health care service or treatment is between the member and his or her health care provider.
2 The data includes only those claims that have been paid by BCBSTX.