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Value-Based Care Slashes Per Member Per Month Costs in Kansas

BlueCross BlueShield of Kansas’s value-based care programs helped significantly reduce per member per month (PMPM) costs for beneficiaries.

BCBS of Kansas value-based care programs lowered commercial member costs

Source: Thinkstock

By Thomas Beaton

- BlueCross BlueShield of Kansas has seen significantly lower per member per month costs for beneficiaries participating in value-based care arrangements, including accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).

In 2017, BCBS of Kansas saw PMPM costs of $17.35 for commercial beneficiaries attributed to ACOs or PCMHs in the state - an amount significantly below the network’s fee-for-service average.

The monthly cost of care for beneficiaries with chronic conditions using value-based care was $6.50 lower than members receiving care under traditional reimbursement models.

Michael D. Atwood, MD, Vice President of Medical Affairs and Chief Medical Officer for BCBS of Kansas, said that the results of the value-based care programs indicate the payer is effectively achieving the triple aim of healthcare.

“That is a significant number that shows our value-based programs are beginning to prove that better coordinated and patient-centered care can result in better health, better experiences and lower total cost of care,” Atwood said.

The payer also noted that value-based care models have contributed to an 8.1 percent reduction in hospital admissions, a 6.43 percent reduction in emergency room visits, and a 17.56 percent decrease in avoidable hospital readmissions.

“When you consider that the roughly one-third of members who have chronic conditions account for about two-thirds of the total cost of care, it becomes evident that one way to lower health care costs for all is to do a better job of efficiently coordinating care for those with chronic conditions,” Atwood said.

Currently, 575 providers provide care to 191,500 beneficiaries through either a PCMH or an ACO.

The PCMH model leverages contracting agreements with providers that focus on continuous and coordinated care. ACO participants at hospitals and their integrated health systems earn financial incentives for improving care quality and reducing costs.

The success of BCBS of Kansas’s value-based care programs follow efforts from other commercial payers who developed value-based programs that lowered costs, improved outcomes, and effectively collaborated with providers.


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