Our new Future of Health Care initiativeApril 17, 2017
Advancing Health Care Value is about ensuring a more affordable and sustainable health care system for everyone – and making a healthy difference in people’s lives. America leads the world in many respects, but our health care system is very expensive compared to other countries, and it doesn’t product world class results. Minnesota has a long history and strong reputation for being a progressive state where health care innovation thrives. We need that same spirit of innovation to advance new ideas and approaches to health care financing and care delivery. We literally can’t afford to keep doing things the same way.
Our new “Future of Health Care” initiative, just announced, highlights ideas Blue Cross is putting in motion to address this challenge in Minnesota and beyond.
I’ve been on both ends of the health care spectrum, serving as chief strategy officer for Children’s Hospitals & Clinics of Minnesota prior to joining Blue Cross, and was director for strategic development at Allina Health prior to my role at Children’s. I know the importance of partnering across the health care community on new ideas and approaches to advance the Future of Health Care.
We’ll need everyone working together if these cost challenges are to be met. These cost challenges are driven by multiple factors: a flawed payment system, fragmented information which hinders care coordination and complicates care consumption decisions, skyrocketing pharmacy costs, significant provider consolidation, and continuing issues of waste and unnecessary utilization of services.
I know health care can be complex and confusing in addition to being expensive. Today’s traditional and transactional care and financing systems are not very consumer friendly. All too often, they create situations that are difficult to understand, make it hard to get information or service and waste time. In a value-based care model, members pay for value and care management, not visits or test or procedures – and premiums tend to be more stable and predictable as well. But to do that, people need to be able to assess and judge the value and cost of various choices, so they can make the best decisions for themselves and their family. We can help lead the way.
In recent years, we’ve focused on value-based provider reimbursement working with doctors and hospitals who share our desire to transform health care – and our new Future of Health
Care initiative expands that focus to new models of collaboration and navigation support for our members.
It’s an important new effort focused on three strategic areas: Clinical Innovation, Care Management and Network & Payment.
In Clinical Innovation, we’ll leverage ideas like the Mayo Clinic Living Donor Kidney Program. Blue Cross worked recently with Mayo and employers to launch this new program, creating “donor chains” to match people willing to help, but perhaps not compatible with a relative or friend, to patients and donors they don’t know who are willing to be a donor for their friend or relative. This type of “paired donation” approach is already being used in 20 percent of Mayo’s kidney transplant cases, resulting in better clinical outcomes and lower costs for Blue Cross members. Blue Cross is also starting to guide members in need of specific orthopedic procedures and those who have low back pain to high value providers.
We recently launched a new consumer-centric diabetes solution, designed in partnership with the American Diabetes Association, featuring digital tools, peer support, care coordination and value-based incentive payments to providers.
A new maternity management pilot, just launched, features early engagement and enhanced support for Medicaid mothers-to-be. This new pilot leverages community and provider partners, including county-based public agencies, to better support women and their babies at this important time.
On Care Management, Blue Cross is helping members with everything from health coaching and utilization management to specialty-care coordination and care transition. We’ll leverage dedicated managers on high-complexity cases, and “cross-functional care teams” to identify holistic and actionable interventions on others.
Network and Payment
In the areas of Network and Payment, we’re continuing to strengthen our focus on identifying and leveraging flexible provider networks based on value, statewide and regionally.
Building on innovations in this area, Blue Cross is aligning incentives in provider contracts to promote quality and sustainable medical cost inflation, leveraging patient-centered medical homes, creating bundled payments, developing value-based contracts for Medicaid providers, and leveraging new Accountable Care Organizations capable of delivering high-value, coordinated care to members in focused provider networks.
Minnesota presents unique challenges relative to rising health care costs. Providers are highly concentrated into systems of care which diminishes competition. Consumers’ value broad provider networks, but lack adequate transparency on cost and quality to make informed choices and Minnesota’s population is aging.
Blue Cross is committed to helping hold the line on costs, while also helping our members more effectively navigate a fragmented and complex health care system. We’d also like to be able to help ensure that health care costs and quality are more transparent, predictable and consistent going forward.
Multiple factors work against that goal. Fee-for-service payment systems, lack of information and transparency to inform care consumption decisions, provider consolidation, rising pharmacy costs, and continuing waste and unnecessary utilization of services all contribute.
The Future of Health Care Initiative
What should we be doing? That’s what our new “Future of Health Care” initiative is all about.
Value-based health care is about helping our members access the right care at the best value. It’s about helping with information and decision support tools. It’s about optimizing networks, and new plan designs that leverage more focused and flexible high-value provider networks.
There is much Blue Cross can do. But we also know we’ll need to continue to spur innovation across communities to build a more stable health care market for Blue Cross members and Minnesotans statewide. We’ll need stronger efforts and greater engagement – and everyone working – to make health care more sustainable.
That’s how we can help Minnesota move forward toward a stronger and better “Future of Health Care.”
About Garrett Black
Garrett Black is senior vice president, health services, at Blue Cross and Blue Shield of Minnesota. As senior vice president of health collaboration, provider relations and medical management, Garrett Black leads Blue Cross’ initiative to create a high performing health care system for Blue Cross members offering affordable, high quality care and optimal customer experiences via new forms of provider collaboration. Prior to joining Blue Cross in 2010, Black served as chief strategy officer for Children’s Hospitals & Clinics of Minnesota. Before his work at Children’s, Black was system director for strategic development at Allina Health.