Quality Blue Program Continues Getting Better Health Results

March 7, 2018

BATON ROUGE, La. –  Blue Cross and Blue Shield of Louisiana’s Quality Blue programs keep leading the way to better health, by using outcome measures to drive improvements in care quality and keep costs in line.

Results from the third full year of Quality Blue Value Partnerships, the insurer’s shared-savings program for Accountable Care Organizations (ACOs), show the approach is working: the 12 network ACOs that were enrolled in the program during 2017 saved an average 4.26 percent on their total costs of healthcare, with the most successful savings reaching 12.21 percent.

“It’s no longer enough to just pay for and provide clinical services as they are needed,” said Dr. Vindell Washington, Blue Cross chief medical officer. “Payers and providers need to be looking at patients’ overall health status and their long-term outcomes. We should focus on how to connect them to the services they need to be at maximum health.” 

As healthcare moves away from fee-for-service, which rewards the volume of services provided, alternative payment models focus on getting more value out of healthcare services, Washington added. “For example, if someone has diabetes, what happens in the doctor’s office is important, but it’s more important to look at your blood sugar control over time.  The important questions are, ‘How are you sticking to a healthy diet, and how are you feeling on most days?’” Washington said.

The Quality Blue programs, which Blue Cross launched in 2013, are a strategic approach to help network providers better care for their overall patient populations, particularly those who have chronic conditions like diabetes, heart disease or high blood pressure.

In Quality Blue, Blue Cross works closely with primary care providers, shares claims data securely and gives them the training, tools and support – including hands-on help from Blue Cross’ own staff – they need to improve quality of care by meeting defined outcome measures, which can lead to lower costs.

For ACOs with primary care providers engaged in Quality Blue, Blue Cross shares overall cost data, using an online dashboard from 3M Health Information Systems, an independent health information technology vendor. Blue Cross staff and staff from the enrolled ACOs work together in teams, collaborating on the best strategies to get patients at goal for targeted health quality measures and lower costs. This partnership helps the ACOs be as successful as possible in the Quality Blue program.

3M Health Information Systems recently published a case study on the success one enrolled ACO, Baton Rouge Clinic, achieved by working with Blue Cross in the Quality Blue program.

In the 2017 program year, providers enrolled in Quality Blue have made significant improvements in managing the chronic conditions that are the focus of the program, with percentages of patients who are successfully staying on top of their health conditions increasing to:

• 34 percent for Diabetes Care
• 71 percent for High Blood Pressure Care
• 40 percent for Heart Disease Care
• 76 percent for Kidney Disease Care

Some of the key ways ACOs worked with Blue Cross to get these results were:

• Referring eligible patients to Blue Cross’ clinical team of more than 200 nurses, dietitians and social workers, who can work with them for health coaching and help them stick to their care plans
• Encouraging patients to see primary care providers for most of their health needs, instead of more-expensive specialty care
• Doing patient education on how to choose the right place to get care and when it’s appropriate to go to the ER
• Focusing on care coordination to make it easier for patients to get the treatment and referrals they need
• Prescribing more generics or other lower-cost, clinically effective drugs

Overall, Blue Cross members who saw Quality Blue doctors had lower rates of ER visits and hospitalizations compared to members seeing other doctors, and their monthly healthcare costs were lower than those of other members.

The ACOs that successfully improved outcomes and held down costs received incentive payments equal to a percentage of the savings they earned.

To learn more about Quality Blue and how this program helps members, visit www.bcbsla.com/MyQBPC.

About Blue Cross and Blue Shield of Louisiana
Founded in New Orleans in 1934, Blue Cross and Blue Shield of Louisiana is a private, fully taxed mutual company, owned by policyholders—not shareholders. It is an independent licensee of the Blue Cross and Blue Shield Association and is governed by a Louisiana Board of Directors.

The company and its subsidiaries provide group and individual health insurance plans, life and disability insurance, group voluntary products and administrative services to Louisiana residents. With headquarters in Baton Rouge and eight district offices around the state, Blue Cross and Blue Shield of Louisiana is committed to improving the lives of its customers by providing them with health guidance and affordable access to quality care.

Learn more on the company’s website at www.bcbsla.comor visit its social media hub to connect via Facebook, Twitter and more.