Blue Cross Blue Shield of Kansas City (Blue KC) is a regional insurer serving the greater Kansas City, Mo., market and two Kansas counties. It counts nearly one million members. In 2009, it launched a patient-centered medical home (PCMH) program with area primary care physicians, which has grown from 67 practitioners at its inception to more than 420 doctors today caring for 110,000 Blue KC members. Building on the success of its PCMH initiative, the insurer is bringing a similar model to area health systems and recently signed St. Luke’s Health System as the first under its new Collaborative Value Program. Senior vice president and chief contracting officer Brian Burns spoke recently with Healthcare Finance News Senior Editor Chris Anderson about using the PCMH model as the backbone of Blue KC’s health system collaborations.
Q: Why did Blue KC decide to launch the Collaborative Value Program focused on hospitals?
A: Well, it’s an extension of what we have done with the primary care physicians with the patient centered medical homes. (With) that program and the reimbursement method under the PCMH, the quality metrics and the attribution of methods we undergo in the PCMH is very similar in the Collaborative Value Program. That data we collect in our system from (all) providers for each patient and what we are able to send back to the primary care practices is what I call a clinical 360-degree view of a patient’s health status. The primary care physician knows of a part of that because he has been treating that patient, but he may or may not have known about the other aspects of healthcare that patient has received from (other) providers because it is a fragmented system. The Collaborative Value Program builds on that, with hospital-employed primary care physicians.
Q: How might an agreement in the Collaborative Value Program differ from one in your PCMH initiative?
A: The programs may differ or deviate from one another based on each specific deal. So incentivizing on one aspect at one system may be different than it is at another system. We emphasize the word collaborative, as this is a team approach with the health systems. We don’t want to go out and say: “Here’s how we want to do it and here is how we want to measure you.” Instead we want to have a collaboration with them and have a program that makes the most sense for everyone. But again, the program has to focus on providing quality access and affordability.
Q: Many insurers have taken the route of working with health systems in an accountable care organization model. Why did Blue KC decide to instead build upon your existing PCMH model for a shared-savings model with health systems?
A: I think our program has more collaboration built into it - built on the PCMH chassis. We say we are all-in on PCMH and that means building the infrastructure. It means funding it. It means putting the provider support consultants out in the community. It includes supporting them with clinical programs. It is all of that wrapped together that makes the Collaborative Value Program stand out from the garden-variety ACO.