BCBSAZ value-based care program shows promising results

Business News | 1 Nov, 2018 |

Change Healthcare and ACO Partner today announced results for the first complete plan year of its novel shared savings program with Blue Cross Blue Shield of Arizona (BCBSAZ). Participating providers reported a 26.3% lower 30-day readmission rate and 28.1% lower all-cause readmission rate than their non-participant cohort. They also reported 20% fewer admissions and 15.2% fewer emergency department visits per thousand treated members. Participating providers also outperformed cohort in achievement of the program’s Quality Index by 2.7%, and drove lower specialty pharmacy spend, decreased imaging utilization, and more High-Efficiency Network (HEN) specialist referrals. Detailed metrics can be found in this  infographic.

High-performing providers in the program were rewarded for progress toward achieving the “triple aim” of reducing costs, enhancing the patient experience, and improving population health. The providers’ level of performance is reflected across key cost and quality metrics relative to the non-participating cohort. Collectively, these and other cost and quality gains led to the Blue Cross Blue Shield of Arizona Shared Savings Program remitting a total of $1 million to 603 participating providers who treated over 41,500 members. Additionally, the program drove a risk-adjusted claims cost trend from 2016 to 2017 that was 3.7% lower than the cohort trend. 

“The model deployed in Arizona, with a focus on care coordination and provider engagement, is achieving the value-based care goals we set when we launched. The program is working for providers and payers, but most importantly for members,” said John Wallace, senior vice president at Change Healthcare and president and chief operating officer of ACO Partner. “The shared savings are just one metric, but when you look at the full range of cost and quality measures tracked through the program, you see that it’s creating more primary care access, and better overall healthcare for members. Leveraging the Change Healthcare portfolio has been a critical element in fostering new levels of payer-provider collaboration and realizing even better efficiency and care quality.”

Established in 2016, ACO Partner is a value-based care organization that is operated by Change Healthcare and Blue Cross Blue Shield of Arizona. ACO Partner contracts independent primary care providers to join the program to earn shared savings, and provides them with sophisticated patient data analytics, care coordination, and provider engagement services. Unlike traditional accountable care organizations, providers can earn rewards for value-based performance but are not charged any membership or service fees.

“With this program, we set out ambitious goals for improving healthcare,” said Dr. Woodrow Myers, Jr., Chief Medical Officer, Blue Cross Blue Shield of Arizona. “We wanted to outperform quality benchmarks and significantly reduce admissions and readmissions among our member population. The results reported for the first full year of operation validate this collaborative approach, and show that working with the resources of Change Healthcare is key to supporting our independent providers, improving care for our members, and controlling inefficient and non-value-added spending. The ACO Partner program’s success is critical for us to achieve our goal of creating a healthier Arizona.”

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