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How Two Innovative Health Plans Are Transforming Care

posted by Alicia Caramenico

on November 10, 2015

The health care system is undergoing a transformation and the health insurance community is at the heart of that change. At a recent congressional briefing hosted by the National Institute for Health Care Management Foundation, top health care leaders showcased how health plans are bringing innovation to the delivery system, whether through value-based payments, international collaboration, or retail centers.

CMS Acting Principal Deputy Administrator Patrick Conway discussed the agency’s goals to link more Medicare payments to quality or value. “Health plans can be a major driver of positive change,” Conway said, emphasizing the important role health plans play in achieving better care, smarter spending, and healthier people.

Blue Cross Blue Shield of Massachusetts is an example of a health plan doing just that. Its innovative Alternative Quality Contract has been accelerating medical costs savings and producing dramatic increases in quality since it began in 2009. It gives provider groups a global budget that covers all medical services and rewards them based on improved outcomes and lower health care spending. BCBSMA President and CEO Andrew Dreyfus credits the ACQ’s success to supporting doctors and hospitals with data and shared learning and continuously evaluating quality measures.

For Florida Blue, it’s shifting the health care system from volume to value by engaging providers and consumers. Part of that involves using retail centers and digital technology to better serve its members. For instance, members can go to retail centers for face-to-face support and learn things like how to use FloridaBlue’s Know Before You Go app. And members appreciate the extra support, according to the 92 percent satisfaction rate for those who visit FloridaBlue’s retail centers, said Chairman and CEO Patrick Geraghty.  The health plan also is working to ensure people are receiving culturally significant, sensitive care in their communities. Geraghty pointed to CliniSanitas in South Florida, where care is tailored to meet the needs of Hispanic individuals and families.

And like FloridaBlue and Blue Cross Blue Shield of Massachusetts, health plans across the country are continuing to drive change, quality, and innovation.