value-based carevalue-based care the health plan view & provider conversations kansas city...

Value-Based CareThe Health Plan View & Provider Conversations

Kansas City Medical SocietySeptember 22, 2015

© 2015 Blue Cross Blue Shield Kansas City. Blue Cross and Blue Shield of Kansas City

is an independent licensee of the Blue Cross and Blue Shield Association.

Getting to Value

• The Health Plan View on Value-Based Care

• Blue KC Medical Home “Listening Tour”



NOW 2018

Secure membership base

and grow and invest in target

market segments

Expand Value-BasedCare Models

Exercise discipline in decision-making

and in financial management of

company

TECHNOLOGY AND SERVICE

WORKFORCE

1 2

Value-based strategy…to manage healthcare costs and improve member health by changing the plan-provider relationship.

Strategies for Success

3



Successful models are much more

than payment arrangements

Advanced provider

capabilities are essential

Working under two competing business models is

challenging

Local market structure and dynamics play an important

role

The National Landscape Lessons Learned



Market Dynamics

THE COMMUNITY MATTERS

Market Support

Employers, unions and government purchasers pushing for new models

Multi-stakeholder community coalitions

Partnerships

A willingness to make investments in healthcare

infrastructure (HIE, All-Payer Claims Database, etc.)

Resources

1 CONRAD, D. A., GREMBOWSKI, D., HERNANDEZ, S. E., LAU, B. and MARCUS-SMITH, M. (2014), Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation. Milbank Quarterly, 92: 568–623. doi: 10.1111/1468-0009.12078



Accountable Care

Members are attributed to doctors who are accountable for their care across the spectrum.

Provider Empowerment

Providers are empowered with new tools and resources provided by Blue KC.

Paying Providers Differently

Doctors are paid in new ways to reward the delivery of high-value services not recognized by traditional fee-for-service payments.

Ongoing Quality & Cost Measurement

Helps doctors improve to deliver high quality care in a cost-efficient manner.

Value-Based ModelsDefining the Standard



Blue KC Medical HomeThe Listening Tour

Meetings with 12 Groups

Practice Size Geography Ownership

Seeking UnderstandingSuccessVision

Obstacles and Challenges

Feedback on Blue KC Role

NCQARecognition



What We HeardWhat Providers Liked…

ACTION SUPPORT PARTNERSHIP

To recognize and improve primary care

With new resources and information

We listen and are willing to

change our role



2015 Listening TourOpportunities to drive transformative change…

Cost Management

Alignment

Administrative Ease



Moving from Listening to Action

Cost Management

Alignment Administrative Ease

• Blue Ribbon Advisory Panel Launch

• New Medical Home provider payment model

• Disease Management/Care coordination nurse realignment

• Value-Based Clinical Consulting Team

• Telehealth benefit

• Lifestyle Coach embedded in practice - pilot

• Doctor directed metabolic syndrome weight loss program – MH pilot

• Digital diabetes monitoring – pilot



Blue Distinction Total CareLocal Strength, National Scale BDTC Designation

• Accountable for care across the care continuum

• Deliver patient-centered quality care

• Agree to ongoing cost & quality measurement

• Accept non-FFS payment

THANK YOU!

value-based carevalue-based care the health plan view & provider conversations kansas city...

Documents