Re-imagining Care Delivery: Insights From Independence Blue Cross

by Anthony V. Coletta, Independence Blue Cross

May 22, 2017

In the United States today, medical progress is rivaled by struggles and inequalities: We have shorter life expectancies, higher rates of disease, and a greater infant mortality rate than Canada, Singapore, and a number of European countries. In Philadelphia alone, the rate of hospital inpatient admissions is more than 31 percent higher than the national average. And costs of health care continue to balloon nationwide – expenditures have risen to 18 percent of our overall economy, the highest of any country in the world.

Making care more affordable, and improving the nation’s health, are distinctly related.

In the face of these challenges, at Independence Blue Cross, we are leveraging our expertise and collaborating with area health systems and doctors to re-imagine how health care is delivered. Through a model we call Facilitated Health Networks (FHN), we aim to create a healthier population by improving the quality of care delivered and reducing health care costs through proactive, coordinated care.

Our FHN model uses many successful principles founded on value-based care –  rewarding doctors and hospitals for the quality and outcomes of care they provide, not the quantity. And while these reimbursement business models are now gaining acceptance, they are only one piece of our overall strategy. Our industry leading model sets us apart through three distinct components:

  • Engage: Working with health systems and doctors on new business models that emphasize shared accountability for the quality and cost of care being delivered rather than volume. This new way of working together, which includes enhanced, innovative contracting models that are based on agreed upon outcomes and real time data sharing, is focused on enhancing quality while bending the health care cost curve in the Greater Philadelphia region.
  • Enable: The exchange of real-time, robust data enables physicians to make informed decisions on appropriate care. The data exchanged through the Independence FHN model includes issues such as specialist and facility utilization and potentially preventable emergency room visits. Combining claims data with electronic clinical records creates a robust platform that can dramatically advance the care of patients.
  • Empower: An ongoing commitment to work closely with health systems and doctors to provide better coordinated patient care. Under the Independence FHN model, a Clinical Care Transformation team works face-to-face with doctors, bringing them tools and reports that help them manage cost efficiencies by showing the comparative cost ranking — low, middle, and high — for frequently performed procedures, while providing them with a holistic view of the population of patients they serve. Independence will also, through this new model, develop care teams that will connect Independence staff with health systems and doctors regularly to share best practices.

Our goal is to work in collaboration with doctors and hospitals for our members and their patients’ best interests, something we all agree on, but haven’t always been able to effectively deliver. Despite all the changes ahead of us in a somewhat uncertain health care environment, one thing that won’t change is our commitment to our members and our participating health systems and doctors.

Anthony V. Coletta, M.D., MBA, is president of Facilitated Health Networks at Independence Blue Cross.