For the first time, Blue Cross and Blue Shield of Illinois will share the cost and quality of services to assist doctors with finding the best healthcare services for their patients.
The state's largest insurer's new partnership with DuPage Medical Group will share data so that DuPage Medical patients understand the types of services they receive when they get care outside the group, reports Crain's Chicago Business.
Under the Affordable Care Act, insurers pay physicians to prevent patients from getting sick to avoid unnecessary hospital visits and procedures. And because traditional payment models rewarded doctors for the quantity of services they provided, as opposed to the quality, Blue Cross recognized the need to rein in wasteful spending.
So over the next five years, the insurer wants 75 percent of its 8.1 million members enrolled in a plan where both physician and insurer can share in savings while improving care and lowering costs, notes the article.
Amid the Department of Health and Human Services' plan to tie 30 percent of all fee-for-service payments to providers to quality initiatives through alternative payment models by 2016, a strong payer-provider relationship is key in order for the industry to transition to paying for value rather than volume.
Blue Cross understood the difficulties providers face when implementing a new payment model, such as large investments and electronic medical records, and is launching this new initiative with just DuPage Medical, which has about 425 physicians.
"Independent physician organizations have come to us and said, 'How do we participate in this space? How are we relevant going forward?' Donna Levigne, vice president of risk-based networks for Blue Cross, tells Crain's. "Part of the opportunity here is really giving them access to (information) they don't have access to today."
- here's the Crain's article