*This article was updated on April 27, 2020.
As a business person you understand the importance of effective and efficient work. There’s nothing more frustrating than spinning your wheels — and spending your money — on efforts that fail to produce positive outcomes. Wellmark understands this as well. And with Wellmark’s value-based care model, you’ll get the same approach to your health plan that you take to your business. Value-based care incentivizes efficiency over waste, an purposeful innovation that provides positive outcomes — resulting in healthier employees and less spending.
What is value-based care?
Value-based care emphasizes the idea that higher-quality outcomes and lower costs can be achieved by making changes to the way health care is delivered. Rather than paying health care providers for services they perform — needed or not — value based care rewards providers for giving proper, effective care that is best for the patient. It aims to transform health care from a system that treats disease to one that prevents disease and improves overall health and well-being.
How does it work?
When your employees select and visit value-based care providers, they are “attributed,” which means their personal doctor is responsible for monitoring their care. To help value-based providers reach their performance targets, Wellmark provides data and analytics about each attributed member. Strong local provider relationships, paired with the national reach of the Blue Cross Blue Shield network, gives us with the richest health insurance data in the country. This combines to give the doctor a full 360-degree view of the member’s health to direct care based on:
- What other doctors or specialists a patient has visited
- What drugs a patient has been prescribed
- What treatments the patient has received
With this information at their fingertips, a health care provider can make better-informed decisions on services needed, diagnoses, medications, and other factors that contribute to the health of the patient. This encourages better performances and success that is measured on specific outcomes such as reduced hospital readmissions, use of certified health IT, and improved preventive care.
Nationally, Wellmark’s Total Care program has decreased the cost trend by 35 percent compared to non-Total Care providers, as measured through Blue Cross Blue Shield Axis®.* Results that led to these reduce medical costs External Site include:
275,000 or 10 percent, fewer emergency department visits.
7 percent better HbA1c testing for diabetes patients.
5 percent better adherence to medications for patients with cardiovascular disease.
15 percent decline in hospitalizations year-over-year.
Locally, Wellmark Accountable Care Organizations (ACOs) continue to produce results in quality and cost outcomes that resulted in a $32 savings per attributed member, per month. These results include:
12 percent decrease in hospital admissions.
22 percent decrease in hospital readmissions.
11 percent decrease in ER visits.
79 percent of members received mammograms.
88 percent of members had a personal doctor.
With proven results like these, value-based care makes sense for both the health of your employees and the health of your business.
Questions? Reach out to your Wellmark representative, or email us at firstname.lastname@example.org Send Email.
*BCBS companies rely on nationally consistent, industry standard measures to monitor the performance of Total Care providers. Total Care measures are aligned with the ACO and PCMH core quality measure set established by America’s Health Insurance Plans (AHIP) and the Centers for Medicare and Medicaid Services (CMS), and uses Healthcare Effectiveness Data and Information Set (HEDIS) utilization measures from the National Committee for Quality Assurance (NCQA).