By Garrett Black - Senior Vice President of Health Services

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Our new Future of Health Care initiative

April 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

Clinical Innovation

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.

Care Management

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.

See Garrett’s full bio.

3 thoughts on “Our new Future of Health Care initiative”

  1. Jill Pederson says:

    My 17 yr old son was recently diagnosed with type 1 diabetes. This whole insulin and all its supplies is new to us. We had issues getting blood glucose strips from our pharmacy in November 2016. I had to buy OTC because pharmacy and insurance BCBS wouldn’t cover. We finally got strips covered in December with BCBS saying there was a glitch in computer upgrade. I submitted a claim to prime therapeutics for reimbursement and they denied. Also a big thank you to BCBS diabetes care manager who helped me go to insulin lantus and novolog websites for $savings. Hundreds of dollars saved. I have a high deductible and pay out of pocket until it is met. I don’t understand why BCBS or pharmacy hadn’t suggested this sooner. I feel taken advantage of having paid full
    Price for insulin for 3 months. And if drug company instantly knocks off hundreds for life dependent meds like insulin why don’t they charge less for it from the beginning. ?? Thank you for the work you do. Positive changes will happen with collaboration.

  2. Todd says:

    In the Network and Payment pillar will you consider steering or at least incenting members to any high quality Joint Commission Accredited hospitals outside of the United States, such as Health City Cayman Islands or CIMA San Jose, Costa Rica for high dollar, medical necessary, episodic procedures such as total joint replacement or cardiac surgery? If not, why not?

    These hospitals and most others around the world already offer bundled payments with high value (cost / quality). You could offer a unique product design for your fully insured block that would differentiate your plan and save money.

  3. Amy says:

    I think you are speaking out of both sides of your mouth and your thinking is driven by dollars with a distant 2nd being best healthcare. Rising costs, best care… my current experience with Blue Cross has not prioritized either. My son was born with a birth defect that has state law supporting insurance coverage. 1. It took 6 months to get my costs paid back on in-network care that is required to be covered by MN state law having gone through multiple review boards. How does that reduce costs as it should have been straight forward, yes BC had to cover, but the overhead of the people who had to cover the numerous phone calls and the several review boards is ridiculous. 2. Your position with Children’s Hospitals and Clinics is offensive. I don’t look at heath care for my children as value-based. I am getting the best care, from experts in their field, with what I believe is minimal follow ups and procedures as that is what is best for my child and not wasteful to either myself of BC. If you have ever had to put your child through multiple surgeries you would understand having the best doctors available and accessible is a a number 1 priority. I will pay out of network for my sons next surgery because I will not choose dollars over what is best for my child.
    Finding doctors that we trust and are confident is surprisingly difficult. I will choose those doctors over insurance everyday and Blue Cross needs to consider that position.

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