Blue Cross MN Value-Based Contract Reduced Cancer Care Costs

Blue Cross and Blue Shield of Minnesota (Blue Cross) has announced that its value-based contract with Minnesota Oncology reduced the total cost of care for patients during the first two years of the agreement.

The payer and Minnesota Oncology, a practice in the US Oncology Network, entered into the value-based agreement in the fall of 2019 to shift away from fee-for-service and improve care quality, costs, and the patient experience.

The five-year contract created care coordination initiatives that aimed to prevent unnecessary trips to the hospital or emergency room and help patients manage their treatment side effects while maintaining a role in their care plans.

Minnesota Oncology care coordinators assist Blue Cross patients starting a new IV chemotherapy regimen and continue to support patients throughout their treatment journeys.

Preliminary data revealed that, under the value-based model, the total cost of care was ten percent lower than the Twin Cities oncology market for Minnesota Oncology patients with Blue Cross employer group coverage.

In addition, patients with employer group coverage saw reductions in emergency visits and inpatient admissions.

“Cancer patients face a big challenge when it comes to the cost of quality, comprehensive care. Under this agreement with Blue Cross, we now have encouraging evidence that our model works,” John Schwerkoske, MD, president and medical oncologist at Minnesota Oncology, said in the press release.

“It is possible to offer state-of-the-art therapies, precision medicine, genetic testing, palliative care, and access to clinical trials while lowering overall costs. These initial results further encourage our efforts in working with Blue Cross to ensure all patients can have access to high-quality care that is close to home.”

As part of the contract, Minnesota Oncology must offer evidence-based best practices that exceed traditional clinical care, such as palliative care, end-of-life care, and social work. What’s more, the provider does not need to receive prior authorization from Blue Cross for services typically associated with high rates of overuse or cost, as the practice has proved that its standards are equal to or beyond those of Blue Cross.

“The early successes of this agreement, along with the collaborative spirit of both organizations, is continuing to grow with a desire to evolve and further improve the model,” said Eric Hoag, vice president of provider relations at Blue Cross. “We are pleased to be adding three new quality measures in 2023, which include social determinants.”

The payer said it will announce future updates on how the value-based agreement has impacted care quality and costs as new data becomes available.

Payers and providers alike have been transitioning away from fee-for-service models and entering value-based arrangements to improve member and patient experiences while reducing spending.

Independence Blue Cross (Independence) recently announced plans to renew its long-term value-based contract with Jefferson Health. The Total Value of Care value-based care program will integrate physical and behavioral healthcare and aim to improve maternal health and cardiovascular health among patients.

In October, Cigna established a value-based care agreement with Heal, an in-home primary care organization, to boost care access for Medicare Advantage members in Georgia, Illinois, North Carolina, and South Carolina.