Blues plan overhauls provider contract to coordinate care

Blue Cross Blue Shield of Rhode Island is working with one of the state's major hospital groups to overhaul their contract, shifting toward a more comprehensive, quality-focused agreement.

Blue Cross and Care New England have agreed to a five-year plan in which Blue Cross will pay the hospital more when it meets certain quality measures, reported the Providence Journal.

"We want to create incentives to better coordinate care and management of these patients, rather than keep them in silos," Blue Cross CEO Peter Andruszkiewicz said in a statement.

The so-called "long-term strategic partnership," which incorporates global payments and quality-based reimbursements, should help improve patients' health, enhance care delivery and prevent cost increases. It also will create a more patient-centered program for maternity care and behavioral health, Providence Business News reported.

"We have mutual interests with Care New England in addressing and treating behavioral health issues in a new fashion," Andruszkiewicz told the Business News. Behavioral health, in particular, faces "tremendously high costs and high levels of inpatient and outpatient utilization; it's a very fragmented system," he added.

Although Blue Cross and Care New England are still working out some of the contract details, Andruszkiewicz said the new contract should become effective by the end of September.

To learn more:
- read the Providence Journal article
- see the Providence Business News article
- check out the Blue Cross statement