Value-Based Programs

A Win - Win Approach

Fueled by the largest provider network in Kansas, BCBSKS is leading the shift towards outcomes-based health care, while continuing to drive greater value out of fee-for-service.

For several years, BCBSKS has implemented the value-based payment model to put a strong focus on provider accountability for health outcomes and patient experience. Providing the support and resources doctors need to succeed with practice transformation.

A win - win approach for both you and your employees:

• Employers: Healthier employees lead to a more productive workforce
• Employees: Improved health care access and health outcomes with a better patient experience

With the gradual shift to outcomes-based health care, the value-based payment model will not completely replace fee-for-service reimbursement. Instead, the focus will be to improve population health and member experiences through the primary care clinic while providing a solution to slow the long-term growth of medical costs.

How it works:

Contracting: BCBSKS contracts with primary care clinics for the value-based program; an ACO or PCMH.

Attribution: Members are assigned to clinics in the value-based program; this is also called attribution of members.

Care Coordination: The value-based clinic is given a financial incentive to coordinate the care of their assigned members. The care coordinators in these clinics provide the following services for their high risk members:

• Patient/member identification
• Care plan preparation, transition support and management
• Patient/member referrals, tests and follow-up care coordination and tracking
• Self-management support
• Medication reconciliation and adherence assessments

Value Index Score: All clinics have outcome measurement with results being gathered and scored. The quality score determines their financial incentive and reimbursement.