Category: Cost of Healthcare, Health and Wellness

The Power of Information: Quality Blue Primary Care Program

By Michael Bertaut, Healthcare Economist

Anyone who has put together a home budget can tell you that the simplest (in theory) way to save money is to spend less. That applies to healthcare as well. At Blue Cross, we spend 84% of your premiums on actual healthcare, so we can make the biggest impact in controlling premium costs by actually keeping healthcare spending lower.

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Blue Cross has tried many different ways over the years to help you keep your out-of-pocket costs and overall healthcare costs under control. We’ve seen our industry experiment with things like gatekeeper primary care (your primary care doctor had to approve all your care in advance), smaller networks of doctors and hospitals (originally based on price), and higher deductibles or cost sharing to encourage people to shop around for the best deal on their healthcare.

Recently, doctors on staff at Blue Cross in Louisiana have discovered something new. Something that can make people healthier AND save money at the same time.

Turns out that about half of all ad­ults in Louisiana have what we have call “chronic conditions,” like diabetes or high blood pressure. Often they don’t know it and can’t feel a thing, but as we see claims data coming in, we can measure these conditions, tell you where they lead AND how much that costs:

  • Blood Sugar A1Cs that go up year after year can lead to insulin-dependent diabetes. That simple transition adds nearly $7,000 a year in new medical costs.
  • Blood pressure above 130/80 that continues to climb can lead to a stroke. That’s $15,000 of new costs in just 90 days.
  • Cholesterol levels that creep upward, especially “bad cholesterol,” can lead to a heart attack. Now we’re talking $21,500 in costs for the first five days!

And all of these can lead to kidney failure, which can mean $100,000 to $200,000 in dialysis expenses, leading to $1 million for a transplant.

All of these conditions can be identified and managed in most cases with relatively cheap medication and fairly simple behavior changes. Primary care docs are experts at helping patients do this. So we designed a program to help the doctors move Blue Cross patients further and further away from these bad outcomes. This program, the Quality Blue Primary Care program (QBPC), pays doctors for making people healthier.

The “Q” docs (they have a big blue Q next to their name on our website) can see our claims data, and we give them special software and training to understand it. Before you ever set foot in their office, they know you are coming, know what drugs you are on and know your medical history, so that when they spend time with you, it is EFFECTIVE time. They can ask you questions that matter, track your results and make sure you are getting further away from the acute event “cliffs” that I described above.

To sweeten the deal, many patients can have their co-payments waived if they see a “Q” doc. Find out if your doctor is in the program. Almost 700 primary care doctors statewide are participating, and we’ve been at this for two years. So far, we’ve seen:

Pre-Diabetics in the program are 12% further away from becoming insulin dependent. People with high blood pressure are 28% further away from a stroke. High cholesterol folks are 32% further away from heart attacks. And the combined improvement in all these conditions has made a 69% improvement in kidney disease measures across the board! Equally exciting, people seeing Q doctors have measurably lower costs month after month that, over time, will begin to help us control healthcare spending.

So it turns out, we can make people healthier AND control costs at the same time. Quality Blue Primary Care makes that possible. Look for your “Q” doc today!

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