Payer Expands Value-Based Care Footprint for Clinical Procedures

Regence BlueShield (Regence) is welcoming new providers to its value-based care program and offering coverage for additional services to lower costs and improve patient health outcomes.

The payer launched its Episodes of Care program in November 2019 and since then it has experienced a 16 percent reduction in costs for orthopedic procedures. The program prioritizes value-based care and reimburses providers based on patient outcomes during their episode of care for a clinical procedure, whether the episode lasts 30 days or up to one year.

Regence is partnering with Signify Health to regulate the value-based payment program.

In addition to orthopedics, the program will now cover additional clinical procedures including cardiac procedures, gastrointestinal conditions, and maternity care, the press release stated.

“Our charge with Episodes of Care is to work closely with providers to deliver a better coordinated experience and lower costs for patients,” Marion Couch, MD, senior vice president of Health Care Services and chief medical officer of Regence, said in the press release.

“Early results and the addition of major employers and new procedures are adding to the program’s momentum and will ultimately help us bring this innovative care approach to more people across our region.”

Regence’s Episode of Care is gaining more members as well, with the Washington State Health Care Authority (HCA), the largest payer in Washington state, joining the value-based care program. HCA’s 363,000 members will be eligible for the program starting in January 2022.

HCA provides health insurance to public employees, school employees, retirees, and eligible dependents through its Public Employees Benefits Board Program and School Employees Benefits Board Program health plans.

“As we continue our value-based purchasing journey, the Episodes of Care program is a great example of what we want to focus on: delivering improved patient outcomes and experiences, coordinated care, and lower costs,” Judy Zerzan, MD, chief medical officer of the Washington State Health Care Authority, stated in the press release.

Regence boasts additional value-based arrangements that are popular with members and see noticeable savings, as noted in a separate press release. These arrangements include Total Care, an inclusive care management model that focuses on preventive care and patients’ overall health.

Around 40 percent of Regence member claims are reimbursed through one of the payer’s value-based care programs, according to the payer’s 2018 year-end data. Its value-based care models have produced higher satisfaction levels compared to traditional models and have reduced healthcare costs by six percent.

Regence offers health plans to around 3.3 million people throughout Washington, Oregon, Idaho, and Utah.

The payer also recently partnered with home healthcare provider DispatchHealth to increase member access to acute home healthcare services. The new program serves members in Pierce County, Washington, and the payer has plans to expand it to more counties in the state this year.

The program provides clinical assistance at home to members of all ages who have acute illnesses such as kidney and urinary tract infections, cellulitis, and heart failure exacerbations. The home healthcare program offers 24/7 coverage with remote monitoring and an emergency call button as well.

A number of payers have launched value-based care programs in 2021 to provide members with high-quality low-cost care.

Blue Cross Blue Shield North Carolina joined a value-based contract with Fresenius Medical Care North America and Strive Health that works with patients who have chronic kidney disease. The payer also launched Healthy Blue in March, its value-based Medicaid managed care program.

Humana implemented a value-based care pilot program in February under Humana Care Support. The program aimed to help Medicare Advantage seniors with chronic disease management.

Value-based care programs often produce better patient outcomes, lower healthcare costs, and higher satisfaction levels, causing more payers like Regence to continue to expand these types of models.