Empire BlueCross BlueShield Rewards Strong Care Coordination
Healthcare payers seeking to improve care coordination may need to look into accountable care organizations and bundled payments.
By - Healthcare payers are often looking for ways to improve care coordination in an effort to enhance patient outcomes and reduce medical spending. Empire BlueCross BlueShield is one healthcare payer that has implemented care coordination measures from The Joint Commission, specifically its Integrated Care Certification (ICC) as part of Quality-In-Sights®: Hospital Incentive Program (Q-HIP®) requirements.
According to a press release from The Joint Commission, Q-HIP was first introduced in 2003 among 91 medical facilities throughout the state of New York. Hospitals operating under this program are eligible to receive financial incentives if they meet quality care measures including improving care coordination.
“The Joint Commission applauds Empire for recognizing the value our Integrated Care Certification brings to its participating hospitals, medical staff and, most importantly, the thousands of members in Empire’s plans who use Joint Commission-accredited and certified organizations for their health care needs each year,” Mark Pelletier, RN, MS, Chief Operating Officer, Accreditation and Certification Operations, The Joint Commission, said in a public statement.
Empire BlueCross BlueShield along with other Blue Cross Blue Shield health plans from 13 states will be providing financial incentives to its hospital networks for meeting Integrated Care Certification from The Joint Commission.
“Our recognition of this standard is a prime example of our plans’ commitment to collaborating with providers to reward high-value care,” Larry Schreiber, President and CEO, Empire BlueCross BlueShield, said in the press release. “At the same time, it reduces the administrative process of meeting those standards.”
When it comes to care coordination and the Integrated Care Certification, The Joint Commission began administering these certificates the summer of 2015 to hospitals, physician practices, and ambulatory care facilities that showed excellent data sharing platforms, transitions of care protocols, and other communication pathways when transitioning a patient from a hospital setting to a rehabilitation center or other facility.
“Hospitals and ambulatory care and physician networks that achieve Integrated Care Certification demonstrate a profound commitment to patient safety and continuity of care. We are very happy that Empire realizes the importance of evaluating coordination of care as patients enter and leave the acute care setting,” Pelletier continued.
By improving care coordination and patient engagement across the entire continuum of care, it is expected that health outcomes will also strengthen. Healthcare providers who are eligible for this certification signifying their superior care coordination skills must have at least one of their departments accredited by The Joint Commission.
Among healthcare payers who are looking to boost care coordination efforts within their provider network, it is vital to consider the benefits of accountable care organizations as well as bundled payment models. These value-based care initiatives could help payers go a long way toward strengthening care coordination and potentially reducing spending.
For instance, last year, the Centers for Medicare & Medicaid Services (CMS) announced that the agency will be implementing an accountable care organization for treating kidney failure patients, which was intended to improve care coordination among this patient population.
This patient population is relatively large with 600,000 people experiencing renal failure around the country. Additionally, these patients are in need of dialysis treatment several times per week, which makes care coordination and accountable care models vital for treating renal disease.
Patients with kidney failure take up nearly 6 percent of all Medicare payments, which is why the accountable care organization is being implemented. ACOs of this kind could lead toward cost reduction while improving or at least maintaining quality of care.
“This new ACO model represents a paradigm shift in care for beneficiaries with end-stage renal disease; it promotes a patient-centered approach to their dialysis and non-dialysis care needs that will help accomplish our delivery system reform goals of better care, smarter spending, and healthier people,” Patrick Conway, M.D., MSc, Acting Deputy Administrator and Chief Medical Officer, CMS, said in a public statement.
This new CMS program is being built using the knowledge gained from the Pioneer ACO Model within the Medicare Shared Savings Program. Healthcare providers including dialysis experts, nephrologists, and dialysis facilities are looking to improve patient outcomes through the use of this ACO model.
Another area that healthcare payers could look into when targeting care coordination is the bundled payment model, which provides payment to multiple providers for an episode of care. The bundled payment model could be used to pay a pharmacist for administering medication, radiologist for CT scans, nurses for hospital care, and a physician for a primary care appointment. Clearly, this would lead to improved coordination between multiple medical facilities.
CMS has gone forward with adopting bundled payments such as through the Bundled Payments for Care Improvement (BPCI) initiative. Healthcare payers would be wise to follow the lead and also look toward value-based care payment strategies to boost care coordination.
Whether it is through bundled payment models, accountable care organizations, or performance-based reimbursement structures like that of Empire BlueCross BlueShield, value-based care goes hand-in-hand with improving care coordination and patient outcomes while reducing spending.
