Press Releases
Blue Cross and Blue Shield Reports on Innovative Provider Partnerships Based on Collaboration
with Harvard Medical School
Today's announcement is part of a first-of-its kind collaboration between the Blue Cross and Blue Shield System and Harvard Medical School to monitor and evaluate local Blue Plan initiatives that help keep quality healthcare affordable. The winning programs were chosen from more than 30 programs submitted to Harvard researchers by Blue Cross and Blue Shield companies throughout the country.
"These six programs were selected because they showed local market success and because they represent actions that can be taken today to keep quality healthcare affordable," said Barbara McNeil, M.D. PhD., who led the Harvard selection process. "The programs we're highlighting today demonstrate that providing incentives for improving healthcare quality and creative care management programs can have tremendous impact on affordability and efficacy."
Blue Plan entries were reviewed by Dr. McNeil and a team of researchers on faculty at Harvard Medical School's Department of Health Care Policy, including David Blumenthal, M.D., and Edward Guadagnoli, Ph.D. The criteria for evaluating the initiatives include the importance of the initiative to the U.S. healthcare system, its breadth of applicability and its level of innovation. The first report focuses on innovative provider partnerships to improve affordability and quality care.
"Better quality care leads to better results for patients and more affordability for everyone," said Scott P. Serota, president and CEO of the Blue Cross and Blue Shield Association. "On behalf of consumers, Blue Cross and Blue Shield companies across the country are some of the leading voices advocating improvements in clinical quality. This report highlights a diversity of programs that can help all of us achieve greater quality and affordability."
Rewarding Quality
In the four selected Blue Plan initiatives to reward quality, Harvard researchers found that
a high number of physicians participated and that the local Blue Plan provided participating
physicians with a significant amount of information to meet their goals. According to the
report:
- Blue Cross and Blue Shield of Illinois' Reducing the Burden of Influenza program gained overwhelming interest as evidenced by the participation of every Medical Group/Independent Practice Association since 2000. Changes in practice that result from this program are likely to encourage preventive services for all, not just BCBS of Illinois patients.
- The Excellus Blue Cross Blue Shield Rochester Rewards Results program provides an excellent example of how numerous aspects of the healthcare enterprise can be integrated and mobilized to improve the quality of care for patients with serious and prevalent chronic diseases. The program recognizes the importance of including patients in their care, thereby encouraging both patients and providers to be partners in the quest to improve quality.
- Blue Cross and Blue Shield of Massachusetts' Primary Care Physician Incentive Program has a strong commitment to improve quality and assists providers to deliver effective, evidence-based care. Patients who need to undergo specific services are identified, and care-related education materials are made available to providers for distribution to targeted patients. Reward providers who adopt computer-based technologies for care management and writing prescriptions is particularly exciting considering the potential to improve the quality of care for all patients.
- The Blue Shield of California initiative to provide secure online communications is a low-cost initiative that is fairly easy to implement on a larger scale, as it improves access to physicians and provides convenience to patients by reducing travel and waiting time and there is a potential for better doctor-patient communication and continuity of care. This cutting-edge program utilizes Internet technology, while effectively dealing with the most common barriers to use cited by physicians (security and lack of reimbursement) and patients (privacy and security).
Care Management
Nearly one-third of Americans with chronic conditions do not receive the information and services
needed for successful self-care and management of their illness. The Harvard research team
selected the following care management programs because of their focus on patient empowerment
and working in partnership with physicians to make available the appropriate tools and information
for effective care management:
- Anthem Blue Cross and Blue Shield's Care Counselor Program deserves acknowledgement for its efforts to empower patients and their families to be effective partners in the management of their care. By developing standardized tools and intervention processes, there is a high likelihood that major components of this comprehensive program can be successfully adopted by other health plans interested in maximizing the quality of care for patients with chronic disease.
- Highmark Blue Cross Blue Shield's Dr. Dean Ornish Program for Reversing Heart Disease addresses an important healthcare problem and is an excellent demonstration of a patient-focused, cardiovascular care management program that can be implemented in a variety of healthcare settings. According to Highmark BCBS, in 2003 the Ornish program demonstrated significant and consistent reductions in utilization as well as improved healthcare affordability.
"Care management programs have become an integral part of preventive care," said Serota. "The two Blue Plan initiatives recognized in this report demonstrate that effective collaboration among physicians, patients and care facilities can lead to better health outcomes and reduce the risk of major health problems for patients with chronic conditions."
