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Value-Based Care — Improving Care and Saving Money

Sep. 04, 2015

As health care costs continue to rise, Blue Cross and Blue Shield of Montana (BCBSMT) is always looking for innovative and cost-effective ways to help you get the care that you need. One solution that has emerged is value-based care.

For decades, many BCBSMT members have benefited from better health outcomes and lower costs as a result of value-based care. BCBSMT anticipates that even more members will start to see these benefits as we continue to expand value-based care arrangements.

What is value-based care?

Value equals Outcome over Cost

Value-based care is designed to reward doctors and hospitals for lowering costs and improving the quality of care they provide you.

In the past, doctors and hospitals have been reimbursed for each test, procedure and other services they perform, regardless if they were needed or if they helped our members get better. With value based care, on the other hand, providers (doctors, hospitals and other health care professionals) are paid based on how well they helped you get and stay healthy. For instance:

  • Did your blood pressure levels go down?
  • Did you have to be reemitted to the hospital soon after their operation?
  • Did your condition get better or worse?

What does it mean for you?

Our goal is to always help you improve your health. Value-based care arrangements will give you access to quality care at the right time, at a reasonable cost. It will help you avoid repetitive and costly medical services and lead to potentially fewer hospital and ER visits. We are working with doctors and hospitals to help protect your wallet and your health at the same time.

How does it work?

There are many value-based care models currently in place to meet the diverse health care needs of our members. You may already be getting care under one of these models and not even know it.

  1. Accountable Care Organizations (ACO) — A group of doctors, hospitals and/or other providers that work collectively to improve the health outcomes and lower the cost of care for a specific group of patients.
  2. Value equals Outcome over Cost
  3. Episode-Based Payments — Providers are given a single payment for all the care to treat a patient with a certain illness, condition or injury. For example, providers would get paid the exact same amount for every patient they see with a heart attack – no matter if the number of tests or other services varies with each patient.
  4. Health Maintenance Organization (HMO) — Your care is managed by a primary care physician (PCP). Your PCP gives you access to preventive care and care management programs and can refer you to specialists if needed.
  5. Medical Homes or Intensive Medical Homes (IMH) — Focus on patients who have complex or chronic health conditions. A primary care provider leads a clinical team that oversees the care of each patient.
  6. Pay-for-Performance — Providers are paid based on how well they improve your safety, health outcomes and costs.
  7. Population-Based Payment — Providers are given a flat per-patient fee to deliver all the care for that group of patients.

All of these models are designed to get you better care at a better price. We are working to expand these models so that more and more members can get greater value from their health care dollars.

Where can I find quality care now?

If you are currently looking for a highly-rated doctor or hospital, use Provider Finder®. This tool allows you to not only search for doctors and hospitals in your network, but also lets you read up on each provider's patient reviews, ratings, awards, recognitions and certificates.

To access Provider Finder, log in to your Blue Access for MembersSM account and go to the Doctors and Hospitals tab.

For more details on our Value Based Care initiatives, view this infographic PDF Document.