Blue Distinction Total Care Doctors, Hospitals and Clinical Care Teams Achieve Better Health Outcomes

Blue Cross and Blue Shield companies slow the growth of the nation's medical costs with value-based care programs

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Apr 26, 2018, 07:00 ET

CHICAGO, April 26, 2018 /PRNewswire-USNewswire/ -- The Blue Cross Blue Shield Association (BCBSA) today announced that the Blue Distinction Total Care^® (Total Care) program, the industry's largest national network of value-based care programs—accountable care organizations (ACOs) and patient-centered medical homes (PCMHs)—is outperforming other care providers in key health care quality and patient health metrics since its launch just a few years ago.

Total Care is also making health care better and more affordable through data-sharing to more effectively coordinate, manage and monitor patient care and by shifting to reimbursement models that put an emphasis on quality instead of quantity of medical services provided.

Launched in 2015, the Total Care program is demonstrating measureable improvements in the management of chronic conditions like diabetes, asthma and cardiovascular disease. In addition, the program is driving a significant increase in preventative medicine, including pediatric health screenings and immunizations. Overall, Total Care doctors, hospitals and clinical care teams are performing better than non-Total Care providers in 96 percent of the nationally-consistent, industry quality measures tracked*. Quality results that reduce medical costs include:

275,000, or 10 percent, fewer emergency department visits
7 percent better HbA1c testing for diabetes patients
5 percent better adherence to medications for patients with cardiovascular disease
15 percent decline in hospitalizations year-over-year

Nationally, Total Care also decreased the cost trend by 35 percent compared to non-Total Care providers, as measured through Blue Cross Blue Shield Axis^®. These results represent significant savings for Blue Cross and Blue Shield (BCBS) customers and the broader health care system. By emphasizing prevention and focusing on wellness, disease management and better coordinated care, Total Care providers are holding the line on costs by keeping patients healthier and out of the hospital.

"Blue Cross and Blue Shield companies created Total Care to bring the most effective, locally developed programs to a national level to better serve the needs of our members and employers," says Kari Hedges, senior vice president, commercial markets and enterprise data solutions for BCBSA. "BCBS companies' local value-based care programs collectively build strong partnerships with doctors, nurses and hospitals that result in measurable health care improvements that help our members receive the right care in the right setting at the right time, while making health care more affordable."

"The very best health care is patient-centered with a continuum of care that fully engages clinical services from a variety of clinicians and clinical services," said Mark DeRubeis, CEO of Premier Medical Associates, the largest multi-specialty physician practice in the Greater Pittsburgh area. "Working with Highmark Blue Cross Blue Shield and Total Care, we are empowered to focus on delivering efficient, high-quality care which drives down health care costs and improves patient outcomes."

Total Care is part of BCBS companies' continued leadership in the shift to patient-focused, value-based care models. Total Care comprises one-third of BCBS network doctors and hospitals, which have shown a commitment to providing better and more coordinated patient care. More than 19 million BCBS members receive care through the Total Care program, a 50 percent increase since the program launched in 2015.

Total Care programs are part of the BCBS System's full portfolio of value-based care programs, which include ACOs, PCMHs, pay-for-performance programs and episode-based payment programs, all aimed at rewarding quality care that leads to better health for patients. Today, nearly 62 million BCBS members have access to care through these innovative care programs across all 50 states and Washington, D.C. BCBSA expects this program to continue to expand in the years ahead.

For more information about Total Care, visit www.bcbs.com/improving-care-nationwide.

*BCBS companies rely on nationally consistent, industry standard measures to monitor the performance of Total Care providers. Total Care measures are aligned with the ACO and PCMH core quality measure set established by America's Health Insurance Plans (AHIP) and the Centers for Medicare and Medicaid Services (CMS), and uses Healthcare Effectiveness Data and Information Set (HEDIS) utilization measures from the National Committee for Quality Assurance (NCQA).

About Blue Distinction Total Care^®
Designation as a Blue Distinction Total Care provider means this provider has met the established national criteria and has been designated by the local Plan. To find out which services are covered under your policy at any facilities, please call your local Blue Cross and/or Blue Shield Plan; and call your provider before making an appointment, to verify the most current information on its Network participation and Blue Distinction Total Care status. Neither Blue Cross Blue Shield Association nor any of its Licensees are responsible for any damages, losses, or non-covered charges that may result from using Blue Distinction or receiving care from a Blue Distinction or other provider.

About Blue Cross Blue Shield Association
The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Index. For more information on BCBSA and its member companies, please visit bcbs.com. We also encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out our blog.