A value-based program is an arrangement with health care providers where a portion of provider reimbursements are based on quality and cost outcomes. The types of value-based programs that are available to our BCBSKS network providers include Patient-Centered Medical Homes (PCMH), Accountable Care Organizations (ACO), and Pay-for-Performance (P4P) arrangements.
Quality Based Reimbursement Program (QBRP)
BCBSKS administers a pay-for-performance program referred to as QBRP that is designed to promote efficient administration, improved quality, and better patient care and outcomes. Even though participating providers must meet certain prerequisites, the program is available to all eligible CAP professional and institutional providers.
Patient-Centered Medical Home (PCMH)
PCMH establishes a partnership between the patient and Primary Care Physician (PCP). BCBSKS launched a three-year PCMH pilot program sponsored by Kansas Primary Care Professional Organizations and the Kansas Academy of Family Physicians (KAFP) in 2011. In 2013, the pilot concluded and BCBSKS launched the BCBSKS Systematic Transformation to Excellence in Medicine (BlueSTEM) program. Through BlueSTEM, the performance of participating PCPs is measured, scored, and used to reimburse providers based on quality outcomes. The BlueSTEM model supports the five primary functions of a PCMH:
- Comprehensive care
- Patient-centered care
- Coordinated care
- Accessible services
- Quality and safety
Accountable Care Organizations (ACO)
An ACO is an integrated health system, or a network of PCPs, hospitals, health care providers (i.e. specialists) who agree to deliver effective (quality) and efficient (cost) care. ACO arrangements are designed to encourage coordinated care and meet performance benchmarks for quality and affordability in order to manage the total cost of care of their (attributed) patient population.
- Blue Distinction Total Care is a national designation program that recognizes doctors and hospitals for their efforts in coordinating total patient care, and have met nationally consistent criteria for patient-centered and value-based care.
- Blue Distinction Specialty Care is a national designation program recognizing health care facilities that demonstrate expertise in delivering quality specialty care safely, effectively, and cost-efficient. The goal of the program is to help consumers find both quality and value for their specialty care needs. The Blue Distinction Specialty Care program includes two levels of designation
- Blue Distinction Centers – Health care facilities recognized for expertise in delivering quality specialty care.
- Blue Distinction Center+ – Health care facilities recognized for expertise in delivering quality and cost-efficient specialty care.