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Category: ACA and Policy, Health Insurance

Healthier Patients, Happier Providers, Lower Costs: Quality Blue’s Success Story

Guest post by Blue Cross and Blue Shield of Louisiana Chief Medical Officer Dr. Vindell Washington

In one of his earlier Straight Talk videos, The Holy Grail of Health Insurance, Mike asked what would happen if Blue Cross and Blue Shield of Louisiana put your doctor on commission?

What if we paid your doctor based on how good of a job he or she was doing at keeping you healthy overall, not just for the time, tests and procedures you get when you’re in the office for an appointment? What if we tied your doctor’s pay to how he or she performed on clinical quality measures for helping patients who have long-term health needs keep those conditions under control?

That is the premise of Blue Cross’ Quality Blue Primary Care program. And it appears we may have found the Holy Grail.

What If …
We started the Quality Blue program five years ago, with the idea that we, the payer, could work more closely with primary care providers in our network to coordinate care, close gaps and, overall, boost health outcomes. We do that by supporting them at doing what they do best (treating their patients) and securely sharing our claims data with them so they’d have a more complete picture of their patients’ whole healthcare experience (since most doctors only directly know what happens with the patients they’re treating in their offices, not what happens when they go to other doctors, clinics, labs, etc.).

That last part is especially important in Louisiana. As you have probably seen, our state ranks at or near the bottom of most health indicator lists.

A big driver of our state’s historically poor health  and high healthcare costs is that we have more residents with long-term conditions like diabetes, heart disease, high blood pressure and kidney disease. Patients with such chronic conditions are typically at a higher risk for bad side effects or other conditions, so they often need more – and more complex – care. And, estimates are that treating chronic conditions like these drives about two-thirds of total healthcare spending.

Here’s the good news – when patients get help and support to stay on top of conditions like those and keep their numbers under control, there is a great opportunity for them to lower or even eliminate their risk for worse health outcomes.

As the largest private health insurer in Louisiana, with a robust network of provider partners around the state, Blue Cross is uniquely positioned to collaborate with providers and improve the health of our shared customers – their patients, our members.

Moving the Needle
With Quality Blue, we’re working more closely with primary care providers than we ever did before. Each practice enrolled in Quality Blue has a Blue Cross staff liaison who checks in with that practice on a regular basis to share information and updates. This has made a tremendous impact on helping people get the care they need when they need it.

For example, if a practice tells Blue Cross that Mrs. Smith is coming in for an appointment this week, and we can see from Mrs. Smith’s claims data that she is overdue for a mammogram, our staff liaison can let the doctor know this before Mrs. Smith’s appointment. The doctor then has information he/she otherwise wouldn’t have known, and now has a great opportunity to talk about it with Mrs. Smith while she’s in the office.

Through the collaboration that goes on with Quality Blue, we’ve also gotten more members connected with our in-house team of clinicians, including nurses, dietitians and social workers, for health coaching, access to community resources and personalized education – all at no cost to the member.

Quality Blue program data through September 2018 show the program’s laser focus on chronic conditions is getting good results. How do we know this?

Well, Blue Cross establishes clinical quality measures for each condition to track health improvement over time. For example, the doctors are tracked to see how many of their patients have blood pressure or blood sugar readings in a healthy range, are taking medication as directed, or are not smoking.

More enrolled primary care doctors are getting their patients at goal for these measures on the chronic conditions targeted in Quality Blue. Since the first full year of the program (2013-2014) through today, there has been:

  • A 26% improvement in diabetes care
  • A 46% improvement in hypertension (high blood pressure) care
  • A 13% improvement in vascular disease care
  • A 10% improvement in chronic kidney disease care

Quality Blue is not only driving better health outcomes, it’s keeping costs in line.

Tulane University’s School of Public Health performed an independent analysis in 2015 that shows patients seeing Quality Blue doctors had lower monthly healthcare costs than patients with similar health needs who were seeing doctors not enrolled in the program.

Top Performers
Quality Blue wouldn’t be the success it has grown into without the partnership of Louisiana primary care providers – so we make a point to recognize and celebrate their success.

At the 2018 Quality Blue Primary Care Statewide Collaborative on Nov. 1, we gave awards to nearly 500 primary care doctors from around the state who earned top scores on the clinical quality measurements for the four targeted chronic conditions – diabetes, hypertension, vascular disease and chronic kidney disease.

You can check out to see the full 2018-19 Top Performers list. Top Performer doctors will also have an indicator next to their names in the Blue Cross network directory.

There are Top Performer clinics, too: The Family Doctors (Shreveport) won the Highest Overall Performance award, achieving the highest average score throughout the program year on the four healthcare quality measures and three efficiency measures that track how well a practice is reducing the use of unnecessary services.

And, four clinics, which all happen to be in the Greater New Orleans area, earned this year’s highest scores on the program’s clinical quality measures:

  • Highest Achievement in Diabetes Care: GSQN: East Jefferson – Lakeview, Dr. Lindsay Ford (New Orleans)
  • Highest Achievement in Hypertension Care: GSQN: East Jefferson Primary Care, Dr. Nicole Giambrone (Metairie)
  • Highest Achievement in Vascular Care: LCMC Touro: Louapre, Kokemor, Sarrat & Braedt (New Orleans)
  • Highest Achievement in Kidney Care: GSQN: East Jefferson Primary Care, Dr. Nicole Giambrone (Metairie)

Innovation to Improve Service
Going forward, how can Blue Cross better support our network primary care providers and keep boosting outcomes through Quality Blue? What can we do in the next five years?

For starters, we’re looking at how we can customize support for the members. We’re focusing more on social determinants of health (a person’s socio-economic status, access to transportation, available food supply, etc.), which can greatly affect both the quality of care a person receives and health outcomes.

We’re working with our in-house clinical team and Quality Blue practices to keep connecting eligible members with free health coaching and care management support.

And, we’re doing more with advanced analytics and Blue Cross’ internal capabilities to predict potentially high-cost, high-need members and intervene sooner to offer them personalized resources and support to help – hopefully before they become very sick or need to go into the hospital for care.

Mike and our team will have more details about all of these efforts, which we’ll keep sharing with you here.

It’s important that we stand with our members in both their moments of illness and their moments of wellness, working with them in achieving their health goals.

As we keep growing our Quality Blue program and making continuous quality improvements, we hope to have even more success to share with you in the years to come.

And lots more to celebrate.

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