Blue Cross MN CEO: Why COVID-19 may be making the case for value-based care 

COVID-19 is making the case for accelerating the move to more value-based models of care. 

Hospitals’ financial struggles as they pause elective procedures during the pandemic highlight the weaknesses in a volume-based system, said Craig Samitt, M.D., CEO of Blue Cross and Blue Shield of Minnesota.

A value-based approach more effectively positions providers to weather such changes, he told FierceHealthcare. 

“If there’s a silver lining to the crisis, it’s that we will now explore a value-based model which is going to be good for patients, good for providers and good for the community,” Samitt said. 

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Providers bled money of late due to the dearth of elective services alongside the high cost of treating COVID-19 patients. Health systems and physician practices of all sizes have been forced to lay off or furlough workers in large numbers to stay afloat. 

Now, health systems are eyeing the move toward again offering elective procedures, but major concerns about safety remain.  

Samitt said he views the pandemic and its aftermath, including the return to normalcy in patient volumes, in four stages. In the first, providers suppress elective procedures—leading to patients also avoiding care for acute needs. 

Data recently released by Cigna backs this idea. The insurer saw significant declines in claims for care for high-risk needs such as heart conditions. 

In the second stage, the industry successfully ramps up its response to COVID-19 and the surge in care needs. He noted that different states are at different points in this transition. Minnesota, for example, is still in the early stages, while other states have been surging in cases for far longer. 

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In the third stage, the COVID-19 surges have subsided, but patients are still hesitant to seek care, and may choose themselves to hold off on elective services. 

“I suspect there will be a period of time where patients will still be reticent,” Samitt said. 

In the fourth stage, the industry finally starts to see a notable rise in elective procedures, though there could still be plenty of patients who choose to wait on those services.  

Samitt said the stages he envisions are a series of rises and falls in volume and having a strong population-based strategy enables a provider to ride those waves more effectively. 

“In a value-based model, the resources allow us to sustain and frankly be stable over the course of the rises and the falls,” he said.