Blue Cross Blue Shield: Total Care program reduced hospitalizations, ED visits

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Total Care providers have cut costs and improved quality significantly over three years, BCBSA says. (jansucko/iStock/Getty Images Plus/Getty Images)

Providers participating in Blue Cross Blue Shield's value-based care program outperformed other health providers in nearly every required quality measure since the program launched in 2015, according to new data released by the insurer this week.

The Blue Cross Blue Shield Association said providers in its Blue Distinction Total Care program—its network of value-based care programs including accountable care organizations and patient-centered medical homes—had 10% fewer emergency department visits and saw hospitalizations decline by 15% year-over year.

Those providers also saw improved hemoglobin levels among diabetic patients and better medication adherence for patients with cardiovascular conditions. In addition to the care quality improvements, Total Care providers bent the cost curve down by 35% compared to other providers.  

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"We're really excited about the data we're seeing coming out of our analysis on the Total Care program," Kari Hedges, senior vice president for commercial markets and enterprise data solutions at BCBSA, told FierceHealthcare in an interview. "We're seeing Total Care really make a difference in consumer's lives." 

RELATED: Still work to be done in transition to value-based care, BCBS of North Carolina's Conway says 

More than 19 million Blues members are enrolled in value-based models through Total Care, a number that's grown by 50% since the program launched in 2015. There are 106 million total Blue Cross Blue Shield members in the U.S.

Savings or improvements have been slow in these models, so achieving accelerated goals required BCBS to work with closely with the providers in their networks to facilitate change, "particularly around understanding data and the information available to them." 

RELATED: 4 reasons ACOs may generate limited savings 

In general, accountable care organizations have produced mixed results to date with slow savings in Medicare's programs leading many providers to drop out. However, in 2016, ACOs in the Medicare Shared Savings Program—the largest program—saved $652 million. 

The federal Pioneer model saved $68 million in 2016, and 11 of 18 Next Generation ACOs saved $71 million for Medicare. 

Total Care has the benefit of a large pool of BCBS plans since it's crucial that these programs can build scale to succeed, Hedges said. Total Care's focus on two models instead of a broad spectrum of value-based care programs also allows it to better meet provider's needs, she said. 

"When you really focus on those types of programs, you can really meet where the providers and patients are," Hedges said.

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