- National health plans are leading the way in alternative reimbursement structures such as bundled payment models and shared saving programs. Blue Cross Blue Shield health plans, Cigna, and UnitedHealthcare have worked to expand their value-based care payment footprint in recent years.
Blue Cross Blue Shield
New York-based Excellus Blue Cross Blue Shield has recently announced partnering with a data analytics and population health vendor Geneia to move forward in value-based care payment structures. A total of 1.5 million of their members will be managed under a population health management strategy.
The data analytics software has led to a 7.2 percent reduction in hospital admissions and a 15 percent decrease in hospital readmission rates among Medicare members. The data analytics technology has also brought an 8 percent decrease in emergency room visits for members of commercial health plans as well as Medicare beneficiaries.
“This upstate New York health plan is taking a strong leadership role to improve collaboration with its provider partners and ensuring the sustainability of healthcare in the community,” said Geneia CEO Mark Caron, CHCIO, FACHE. “We look forward to helping them achieve their goals.”
The national payer Cigna will be expanding its footprint in value-based care payment models through a partnership with Scripps Health, according to an announcement made last week. Companies with 100 employees or more will be offered Scripps Select HMO in the San Diego area by April 1. The contract between Cigna and Scripps Health is based on a pay-for-performance structure.
“We have a unified purpose – to put the customers we serve at the center of all we do, and help them access affordable and personalized care."
“Our joint approach to health care is different from a traditional one because it’s based on very close integration between Cigna and Scripps Health,” Gene Rapisardi, President and General Manager for Cigna's Southern California and Nevada markets, said in a public statement.
“We have a unified purpose – to put the customers we serve at the center of all we do, and help them access affordable and personalized care. We recognize that health care is local, so our goal is to create the premier local plan that exceeds the expectations of San Diego employers and their employees,” Rapisardi explained.
The third example of value-based care payment expansion comes from UnitedHealthcare. The health insurance company has invested in accountable care organizations to reduce hospital admission rates and improve healthcare quality scores.
UnitedHealthcare released a report last year outlining the benefits of value-based care payment models such as greater care coordination and a focus on improving patient outcomes.
“Value-based Care represents another big step forward in ways we can address both the quality and cost of health care,” according to the report from UnitedHealthcare. “But the movement is toward a health care model that puts greater emphasis on keeping people healthy.”
“One that rewards physicians for working collaboratively to coordinate care, for providing the appropriate care for each patient’s situation, and for driving more positive health outcomes. One in which a care provider’s compensation is based increasingly on keeping a population healthy, rather than on how many tests or services are ordered.”
The investment in accountable care organizations brought positive results for UnitedHealthcare. For example, 83 percent of commercial ACOs saw better outcomes on quality measures when compared to non-ACOs.
Also, UnitedHealthcare saw a 2.3 percent reduction in hospital readmission rates among patients who were treated in a value-based care environment. Commercial accountable care organizations had a 6.3 rise in breast cancer screening and a 7.8 percent increase in colorectal screening when contrasted against non-ACOs.
Other health insurance companies that have not expanded their value-based care payment strategies and are mostly operating through fee-for-service reimbursement structures may need to catch up with national payers in order to compete effectively in the insurance market.