Blue Cross Blue Shield of Minnesota
Program Location:
Minneapolis, MN
Payer Type:
Commercial
Parent Program:
Payers:
Blue Cross Blue Shield of Minnesota
Blue Plus (Blue Cross Blue Shield of Minnesota)
Reported Outcomes
Description:
Blue Cross and Blue Shield of Minnesota offers a “shared incentive” payment model with four of Minnesota’s largest care systems. The model is “designed to make healthcare more affordable and to improve the health status and quality of care delivered to the Blues plan’s members,” the plan says. The approach “is designed to create a longer-term, collaborative partnership approach where hospitals and clinics are rewarded for providing care that improves quality and utilizes resources effectively. The resulting quality improvements and cost savings will benefit Blue Cross members and clients and the community in the form of measurable improvements in clinical and health outcomes, lower medical cost trends and reduced premium increases.”
Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) accept certain claims for payment of health care home (HCH) care coordination services. The development of health care homes in Minnesota is part of the health reform legislation passed in Minnesota in May 2008. The legislation includes payment to providers for partnering with eligible patients and families to provide coordination of care. Blue Plus' Minnesota Department of Human Services (DHS) 2010 Contracts required that individuals with complex or chronic conditions be able to access services through a certified health care home by July 1, 2010. These provisions impact individuals enrolled in Minnesota Health Care Programs (MHCP), including Blue Advantage, MinnesotaCare, SecureBlueSM (HMO), CareBlueSM (HMO), Minnesota Senior Health Options (MSHO), Special Needs Basic Care (SNBC), and Minnesota Senior Care Plus (MSC+). These health care home provisions also impact the Minnesota Advantage Health Plan offered by the State Employee Group.
Payment Model:
In the shared-incentive model, physicians, clinics and hospitals continue to get paid a basic rate, as in the traditional fee-for-service model. But over the length of the agreement, the focus is less on guaranteed rate increases and more on incentive payments tied to measurable improvements in quality and to reductions in the overall cost of care. Care systems are rewarded for becoming more efficient and effective as well as for quality results in key areas.
Fewer ED / Hospital Visits:
Providers continue to struggle with Readmissions and ED Visits for the MSHO population.
Improved Health:
Aggregate AIC/PCMH 2016 performance is greater than the MN Average as reported by Minnesota Community Measurement for all measures: Optimal Asthma Care; Optimal Diabetes Care; Optimal Vascular Care and Depression Remission at six months. All measures are exceeding goal by being at least 1 percentage point greater than MN average and with an average variance of 3 percentage points over MN Average. The most noticeable difference is with Optimal Asthma Care for adults being 6.5 percentage points greater than the MN average.
Aggregate AIC 2016 performance for Colorectal Cancer Screening Non‐Caucasian population exceeds goal with a rate of 64.6% compared to the MN Average rate of only 60.3%. AIC providers continue to outperform when compared to the rest of the Minnesota provider community making strides to close the disparity gap for people of color.
Data Source(s):
Last updated June 2019
