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How clinical partnerships lead to better value for patients

Originally published in The Tennessean, April 2024

No matter where we are on our individual health journeys, we all want the same things: confidence in our caregivers and their treatment plans, lower costs, and a better overall experience.

As patients, we want to feel supported throughout our journey — by insurers, providers and even the employers who fund our benefits.  And while the nature of the health care industry means we’re all connected, we want that to translate to open lines of communication, alignment and positive outcomes.

The best of both worlds

At BlueCross, we strive for this peace of mind for our members every day. As health care costs continue to rise, employer groups are increasingly asking what we’re doing to save their employees money. We came up with a solution that delivers better outcomes and lower costs.

The Medical Home Partnership (MHP) is a program that rewards our provider partners for the value of the care they administer, not just the quantity of services a member receives.

MHP was designed to improve our commercial-plan members’ overall wellbeing, address treatment and medication cost increases through effective collaboration with health care providers, and reduce unnecessary ER trips. Management teams across the state and a clinical infrastructure have allowed us to develop relationships with our primary care practices, particularly their quality teams.

Much of the MHP early work focused on practice transformation — reviewing workflows, leveraging the electronic medical record, and educating providers and members on addressing gaps in care, best practices, evidence-based recommendations for preventive care. From there we moved into helping providers better understand the communities and populations they were responsible for.

BlueCross care coordinators are embedded within many MHP practices several days a week,  physically working alongside the health care team. They also interact directly with members, helping them schedule preventive screenings and ensuring they’re getting the right tests to manage their chronic conditions.

If a member visits the hospital or emergency room, we receive that data and work with the member if they need to follow up with their primary care physician or specialist.

A shared approach

Identifying member needs and conducting the proper outreach are key components of the MHP philosophy and help determine who we want to partner with.

Providers need to share our goals of quality improvement, commit to quarterly meetings with us to discuss successes and areas for improvement, and welcome our care coordinators to their practices and see the value they bring.

These partnerships start with engaged executive leadership — that engagement trickles down.  So, when we’re meeting with the physician champion or a quality director, it’s a much easier conversation because we’re all there for the same thing — to improve the care for the member.

Today the MHP program has:

  • 20 participating groups, typically larger health systems and primary care offices
  • 672 locations
  • About 2100 participating providers
  • More than 400,000 members seeking care within those offices

In a recent evaluation, MHP practices scored significantly higher on 18 of 25 nationwide quality measures from the National Committee for Quality Assurance  when compared to practices who don’t take part in these value-based arrangements. In addition, for every dollar invested in MHP, we’ve reduced member cost by $8.

Addressing quality, convenient care for all

We’ve started the conversation about health equity with our MHP practices to ensure we’re meeting that goal of convenient, high-quality care for all. We’re working with these providers to collect more direct data about demographics so that we can better understand health disparities.

More data helps us drive action, but the rubber meets the road only when our members are healthier and inspired to maintain that continuity of care.

BlueCross members who receive care from MHP providers overwhelmingly report positive care experiences, achieve better health outcomes, and are less likely to receive unnecessary care. And that’s an accomplishment we can all celebrate.

About Allison Scripps, Director, Provider Performance and Quality

A photo of the authorIn her role, Allison helps ensure the success of our Medical Home Partnership program and the care coordinators who embed themselves within these practices.

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