Value-Based Care: Smarter Care for Better Health
Blue Cross and Blue Shield of Montana (BCBSMT) is committed to setting up value-based arrangements with health care providers that aim to deliver smarter care for better health.
The value-based care models are designed to:
- Reward doctors and hospitals when they help members improve their health
- Focus on quality that may lower employer group health care costs
- Improve the health care experience for members
- Increase collaboration among health care providers
Our approach to developing value-based care arrangements is helping shift the industry’s focus from paying for more services to paying for better care and outcomes.1
Value Based Care
At BCBSMT our goal is to develop ways to help our contracted providers improve health care and reduce the overall costs of care. Our value-based care models show our evolving steps for balancing quality and affordability:
This program incentivizes contracted hospitals to reduce:
- Mortality rates
- The number of days in the hospital
All incentives focus on exceeding quality performance levels.
Blue Distinction Specialty Care
Blue Distinction Centers for Specialty Care®, a Blue Cross and Blue Shield Association (BCBSA) designation, recognizes contracted health care facilities that have a track record of delivering better overall care for certain diseases or treatment including:
- Bariatric Surgery
- Cardiac Care
- Complex and Rare Cancers
- Knee and Hip Replacements
- Spine Surgery
Blue Distinction Total Care (BDTC)
Starting in 2015, BCBSA is introducing BDTC as a national designation. It will recognize contracted doctors and hospitals for their efforts in coordinating total patient care.
Saving with BCBSMT Value Based Care
Our cutting-edge contracted provider arrangements work to lower total spending by:
- Increasing Accessibility to Patient History
We’ve built tools that pull two years’ worth of claims history data at a time.2 This gives contracted health care providers a clearer picture of treatments their patients have – or haven’t – completed within the two year period.
- Tailoring Specialty Care Costs
Group health care benefits programs can be adjusted to help meet cost objectives. For example, employee copays may get lowered when visiting Blue Distinction Centers® and Blue Distinction Centers+SM.
- Making Health Care More Accountable
BCBSMT works with contracted providers to create a team-based, primary care approach that aims to offer the right care at the right time.
- Measuring Performance Results
We use data to:
- Measure success
- Provide financial incentives to providers
- Drive clinical and quality performance
Offer Smarter Care for Better Health.
Contact your BCBSMT Account Executive with questions on value-based care.
1 Prior results are not a guarantee of any future results and individual results may vary. The programs are tools to assist the independently contracted providers in rendering care to members. The final decision about any health care service or treatment is between the member and his or her health care provider.
2 The data includes only those claims that have been paid by BCBSMT.