BCBS Minnesota’s Collaboration Leverages Technology to Support Value-Based Care and Payment
On May 25, the leaders of the Egan, Minnesota-based Blue Cross Blue Shield of Minnesota (BCBSMN) published an announcement regarding the health plan’s collaboration with four diverse provider organizations in Minnesota, and their investment in technology to support that collaboration.
The announcement, carried in a press release, began thus: “Blue Cross and Blue Shield of Minnesota (Blue Cross) announced today that it has funded investments in technology and practice support resources for four independent medical care organizations across the state, allowing new capabilities in optimizing the quality of care for patients and overall financial management. Entira Family Clinics, Integrity Health Network, St. Luke's Hospital and Winona Health are now connected to a web-based data analytics and care coordination platform from Stellar Health (Stellar), a health care technology company that provides insights into quality and cost of care measures while facilitating real-time financial rewards for appropriate care coordination practices,” the health plan stated.
The press release continued thus: “In 2020, Blue Cross announced a collaboration with Stellar and the Minnesota Healthcare Network – a group of 47 independent primary care clinics in Minnesota and Wisconsin – to accelerate the transition to value-based payment and provide financial resources for long-term stability. With this most recent expansion, more than 500 independent primary care providers across Minnesota are now participating in this value-based program.”
The press release quoted Karen Amezcua, senior director of provider partnerships at BCBSMN, as stating that "Blue Cross recognizes the transition to a value-based care payment model can be especially challenging for independent providers. That is why we're committed to providing infrastructure and financial support to independent providers participating in value-based care throughout the state, with the goal of ensuring high-quality care at a lower overall cost for our members."
The press release noted that “Additional compensation will be provided to health care practitioners and their staff upon completion of appropriate care coordination activities. Over time, this will lead to better health outcomes, as all patient care decisions and recommendations are informed by data-driven insights and best practices.” And it quoted senior executives from the four participating patient care organizations, including Kim Terhaar, vice president of ambulatory care at St. Luke’s Hospital. "Managing complex health conditions is critical to delivering optimal health outcomes at a lower cost for St. Luke's patients," Terhaar said. "This innovative collaboration with Blue Cross enables us to more seamlessly transition to a value-based care delivery model."
Further, Rachelle Schultz, president and CEO at Winona Health, reported that "The Stellar platform has been instrumental in supporting breakthrough performance in identifying and addressing clinical gaps in care and ensuring our providers have the information they need in their delivery of high-quality, patient-centric care to our patients. The demands on physicians and clinicians are growing so we must find better ways to support them in their work so that they can focus on what is really important – the patient. Blue Cross and Stellar are helping us do just that,” she said.
And Michael Meng, CEO at the New York City-based Stellar Health, said that "We are honored to assist Blue Cross in their effort to help independent providers find success in value-based care. By rewarding each value-based action completed, Stellar and Blue Cross are helping to create economic stability for independent providers as they move away from an unsustainable fee-for-service model." As described on its website, “Stellar Health is a healthcare technology company that helps payors, health systems and provider networks, and practicing physicians improve quality and financial performance by prompting providers and their care staff with recommended value-based actions and real-time payments at the point of care. Our vision is to power the delivery of all the best-in-class value-based care activities that providers can take to lead to better patient outcomes.
As stated in the press release, “For nearly 90 years, Blue Cross and Blue Shield of Minnesota (bluecrossmn.com) has supported the health, wellbeing and peace of mind of our members by striving to ensure equitable access to high quality care at an affordable price. We are on a mission to inspire change, transform care and improve health for the people and communities we serve by reinventing both ourselves and the broader system. Our more than 2.5 million members can be found in every Minnesota county, all 50 states and on four continents. As a proud nonprofit organization, we believe working to advance wellness for all Minnesotans is the greatest investment we can make. Our goal is nothing less than for everyone to be able to achieve their full health potential, regardless of race or other socially defined circumstances. Blue Cross and Blue Shield of Minnesota is an independent licensee of the Blue Cross and Blue Shield Association, which serves more than 107 million members across the U.S.”
This week, Karen Amezcua spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding how this collaborative initiative connects to Blue Cross Blue Shield of Minnesota’s broader efforts to connect with and collaborate with hospitals, medical groups, and health systems throughout the state. Below are excerpts from that interview.
Your announcement a week ago spoke to a broader overall strategy to partner with provider organizations to improve patient and financial outcomes. At a high level, how would you articulate your overall strategy when it comes to providers?
In 2019, Blue Cross and Blue Shield of Minnesota made a commitment to bend the cost trend from what was expected by 10 percent over 5 years, in an effort to improve the long-term sustainability of health care in Minnesota. We believe we will be most successful in achieving this goal by establishing deeper provider partnerships with care systems and supporting independent providers. With that in mind, we knew we would need to change how we approach value-based contracting with providers by collaborating more closely. This meant we would need to reinvent how we work with providers by beginning to uncouple reimbursement from fee-for-service, and by investing in data and enablement resources to help ensure success.
What does that look like in practice?
Part of that is creating new roles and redefining roles around how we support providers. Historically, we negotiated value-based incentive arrangements and shared comparative data but really expected the provider to determine what activities needed to occur to drive performance. We are now working on being more consultative on the opportunities that exist, but also providing enablement strategies and resources to drive performance.
This could be through engaging the Care Management teams at both organizations on coordinated strategies to manage our mutual patients/members in a more coordinated way, driving administrative simplification efforts so we can redeploy resources to drive population health, and explore opportunities for how we can reinvent care through strategies like telehealth or hospital at home. This is a major shift and not all providers are ready to start the transition away from fee-for-service.
Can you drill down on what it means that some provider organizations aren’t yet ready?
For example, some providers already have strategies in mind for how they will address health care costs and bring these efforts to us to partner on implementation. Other providers are committed to driving sustainability but may not have all the tools and resources to deliver results. This is where we want providers to leverage us for support. Stellar Health is one example of how we’re supporting providers on this journey to make health care more sustainable.
One important element in this is the need that providers have expressed for collaboration around data and analytics, in order to move forward in quality-based contracting. They’ve particularly been asking for help from partnering health plans around marrying clinical and claims data. Can you speak to those wishes?
Yes, we have invested in data and analytic tools to help us gain a better and deeper understanding of what is driving provider performance. For example, we not only want to identify where a particular provider’s costs are relatively high, we also want to understand what is driving those costs. Is it utilization? Price? Practice patterns?
We are trying to provide more insightful data to help determine what specific strategies can be put in place to drive results. This information can be leveraged by our Care Reinvention Team of clinicians and medical directors to help partner with providers on opportunities that are identified.
One of the more sensitive questions, for some, is whether this road ultimately leads to some form or forms of capitation. Is that term one that you are cautious in using? How do you feel about it?
I think this is where we are going. We need to transition from a system that is reliant on the sheer volume of services occurring for providers to be successful. This became extraordinarily apparent in the pandemic. The challenge is transitioning the underlying economics to a more capitated, risk-based model.
As part of our collaborative work with providers, we have begun exploring transitioning a portion of provider revenue to population health or partial capitation payment. This would provide a revenue stream to support caring for populations in non-traditional ways.
So it’s a form of partial capitation, then?
Yes, it is creating a consistent and dependable revenue stream to manage the population that is not reliant on utilization, within an agreement that commits to overarching quality and cost targets.
Does that help to flip behaviors?
It is difficult to convert from the fee-for-service mindset, but COVID-19 demonstrated the benefit of reliable revenue not based on utilization levels. So, I think one silver lining of the pandemic is that it has helped get us moving in the right direction.
Providers, employers and plans all want to ensure we are compensating population health appropriately. So, as we innovate on new care models, for instance, we do need to check ourselves on how much are we worrying about the per widget reimbursement vs. the long-term value that reinvention can bring.
The CEO of one multispecialty physician group in California told us that being largely capitated made a huge difference for her and her colleagues in the spring and summer of last year, when, in contrast to the physician groups still largely being paid via discounted fee-for-service, their group did well during the time that CMS [the Centers for Medicare and Medicaid Services] had disallowed elective procedures. Could the fact that such medical groups did well last year during the worst of the pandemic, help to encourage medical group leaders in other parts of the country, to move forward into risk-based payment?
The pandemic was the ultimate use case for capitation. I think our market aspires to get there but it will take time and practice. Theoretically, value-based arrangements are a form of capitation, but the gain and risk opportunities need to be at a level that one can’t afford to revert back to fee-for-service.
With regard to your collaboration with the four provider organizations in Minnesota, you’re actually leveraging technology to support that work, correct?
Yes, Stellar Health is an application that delivers information in a simplified way of value-based actions that need to be addressed by doctors and/or frontline staff. Blue Cross uploads information to help the provider more easily determine what gaps of care need to be filled. This gives independent providers, who may not have the resources to invest in technology, people and processes, the tools they need to be successful in value arrangements.
