Blue Cross Blue Shield Association Announces Largest National Network of Patient-Focused Care Programs

Blue Cross Blue Shield Association (BCBSA) today announced the creation of Blue Distinction Total Care (Total Care), the industry’s largest national network of patient-focused care programs that shift from the fee-for-service model—which rewards the volume of medical services provided—to one that pays medical professionals for quality care and effectiveness in treating patients while making health care more affordable.

Total Care is available to national employers and their employees. It comprises nearly 450 patient-focused care programs in 37 states, and the designation will expand to more hospitals and medical professionals and to more markets in the coming years. Nearly 13 million Blue Cross and Blue Shield (BCBS) members have access to care through Total Care, and this number is expected to grow as more employees of multi-state employers participate. Total Care estimated savings were more than $840 million over traditional payment models on an annual basis.

“Blue Cross and Blue Shield companies are leading the transformation to a better health care system that helps people access better, more affordable care. Our programs emphasize prevention, wellness, disease management and better coordinated care while reducing costly duplication and waste in care delivery,” said Trent Haywood, M.D., J.D., chief medical officer for BCBSA. “Through Blue Distinction Total Care, BCBS companies are bringing the most effective, locally-developed, patient-focused care programs to a national level to better serve the needs of national employers and their employees.”

Total Care today includes nearly 118,000 medical professionals—over 59,000 primary care professionals and nearly 59,000 specialty clinicians—that strive to improve health care quality and efficiency.

The breadth of BCBS patient-focused care models collectively makes the 36 independent companies the market leaders in developing and executing these programs. BCBS companies are now directing more than $145 billion in medical spending—or more than a third of total medical claims annually—through these programs from July 1, 2014, through June 30, 2015.

BCBS companies around the country have documented reductions in emergency room visits, as well as fewer hospital admissions and readmissions. At the same time, there have been measurable improvements in prevention, including improved cholesterol control, better adherence to best practices for treating diabetes and higher rates of screenings and immunizations.

A BCBSA survey reveals a vast portfolio of more than 700 locally-developed, patient-focused care programs in 49 states and Washington D.C. The companies have engaged with nearly 327,000 medical professionals and 2,000 hospitals to increase quality and hold the line on health care spending. More than 42 million BCBS customers are currently accessing care through these innovative care programs.

The entire Blue Cross Blue Shield System portfolio includes accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs, all aimed at rewarding quality care that is effective and efficient and that leads to better health for patients. The programs also encourage and support clinicians and hospitals in modernizing their practices and coordinating their patients’ care.

Total Care comprises nearly two-thirds of all BCBS patient-focused care programs and includes select accountable care organizations and patient-centered medical homes that provide incentives for quality care that is effective and efficient, and which leads to success in treating patients.