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Value-Based Care: Smarter Care for Better Health

Blue Cross and Blue Shield of Texas (BCBSTX) is committed to setting up value-based arrangements with health care providers that aim to deliver smarter care for better health.

The value-based care models are designed to:

  • Reward doctors and hospitals when they help members improve their health
  • Focus on quality that may lower employer group health care costs
  • Improve the health care experience for members
  • Increase collaboration among health care providers

Our approach to developing value-based care arrangements is helping shift the industry’s focus from paying for more services to paying for better care and outcomes.1

 

Value Based Care

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:

Accountable Care Organization (ACO)
  • Hospital Admissions
  • Readmissions
  • 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:

  • Complications
  • Readmissions
  • Mortality rates

All incentives focus on exceeding quality performance levels.

Blue Distinction

Blue Distinction 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
  • Transplants
  • Complex and Rare Cancers
  • Knee and Hip Replacements
  • Spine Surgery

Blue Distinction Total Care (BDTC)

Starting in 2015, BCBSA is introducing BDTC as a national designation. It will recognize 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+SM.
  • 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 Executive 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.