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ACOs Results Prove the Future is Value-Based Care

March 18, 2020

The fee-for-service model is outdated, expensive and not based on quality or results. As an industry, we are long overdue for a paradigm shift – one that incentivizes value, quality and outcomes. Looking at the year-over-year growth and increased savings for members in our ACOs, evidence confirms the future is now for value-based care programs.

What is an ACO?

ACOs are groups of doctors, hospitals, or both, who voluntarily unite to provide coordinated, high-quality, comprehensive care to their patients. Providers are rewarded for keeping patients healthy rather than requiring additional or recurring services.

What do the cost-savings look like?

Since 2015, BCBSTX had an 81% increase in contracted ACOs resulting in 90% of our members being seen by ACOs. Now, we can cover more than 1.2 million of our members through 27 contracted ACOs with primary care providers in 90 counties across the state. In those four years, we’ve seen nearly $110 million in aggregate savings.

What is the value proposition for our members?

ACO members experience:

  • $8.33 lower cost per member, per month.
  • 2.6% fewer emergency room (ER) visits.
  • 8.0% fewer outpatient visits, which are made to a hospital outpatient department.
  • 4.1% more office visits, which are designed to discuss new or existing health issues, concerns, worries or symptoms.

Our contracted ACOs that have operated for three or more years are performing at a $9.94 lower cost per month per members (or member) inside an ACO compared to those treated outside.