|BCBS Companies Highlight Successful Private Market Strategies For Improving Health
Chronic care management programs, integrated health
management solutions, and prevention and wellness programs are some of
the successful innovations by Blue Cross and Blue Shield (BCBS)
companies that are helping to reform healthcare and deliver improved
outcomes and lower consumers’ and employers’ costs.
As policymakers work to develop comprehensive healthcare
reform legislation, the chief executive officers from BCBS companies in
Michigan, New Jersey and Kansas City shared examples of how their
health plans are transforming the delivery system today in ways that
cannot be replicated by the public sector, said Scott P. Serota,
president and CEO of the Blue Cross and Blue Shield (BCBS) Association.
"Provider incentives to promote the best care, working
with employers to craft custom-designed benefit programs instead of a
one-size-fits-all approach, and programs that empower patients,
providers and employers with tools that are leading to improved
outcomes and savings are examples of healthcare reform available only
through private innovation," said Serota.
"Government-run programs, such as Medicare, face
enormous political pressures and are simply unable to implement these
key improvements," he said.
In New Jersey, for example, a patient-centered medical
home pilot program led by Horizon BCBSNJ is improving the quality of
care, while simultaneously lowering healthcare costs for 1,300 enrolled
members by 12 percent between January 2007 and January 2008.
The program has since been expanded to include another 6,000 participants.
The patient-centered medical home, where a
patient’s personal physician directs a team of healthcare
providers in the comprehensive planning and treatment of a patient,
proved particularly successful increasing the number of patients with
diabetes receiving critical screenings. Prior to the start of the
program in January 2007, only 33 percent of the patients with diabetes
had taken an LDL diabetic blood test, which measures cholesterol. By
January 2008, 88 percent of the patients had taken the test.
"Making sure that diabetic patients get their required
testing reduces costs, but more importantly keeps them healthy and
improves their outcomes," said Bill Marino, president and CEO of
"Having the personal physician responsible for arranging
appropriate, evidenced-based care at the practice level and involving
the patient in the treatment planning process is particularly useful
for patients with chronic illnesses."
BCBS of Kansas City is working with more than 200 large
employer groups representing 120,000 individual employees in it’s
"A Healthier You," a turnkey health and wellness program that is
encouraging healthy lifestyle decisions that reduce medical costs and
increase employee productivity.
Emergency room visits – and their costs – by
A Healthier You participating companies are down, while ER visits by
non-participating companies have increased by 17 percent. Overall
wellness scores of participants are up, blood pressure and cholesterol
levels are down, and overall medical costs have grown at a slower rate
– growing 10 percent – for those participating in the
program versus a 17 percent increase in overall medical costs among
"The statistics are startling – nationwide nearly
70 percent of all healthcare costs are the direct result of the
lifestyle choices we make," said Tom Bowser, president and CEO of BCBS
of Kansas City. He noted that the rate of obesity among adults has
doubled in the past 25 years to more than 30 percent of the adult
population and that childhood obesity has tripled over the past 40
"The future of healthcare cost containment lies in
disease prevention and increased member accountability for lifestyle
behaviors," Bowser said.
Blue Cross Blue Shield of Michigan’s (BCBSM)
"BlueHealthConnection" (BHC) offers members a full suite of wellness
and care management services such as a 24/7 nurse call line and an
e-health portal, which features resources including online health
assessment tools and self-care guides that allows for proactive,
integrated approach to total well-being of the whole person. It
connects with members across entire continuum of healthcare needs, from
low-risk/wellness to existing chronic conditions and catastrophic
conditions. Combined with claims experience, BCBSM is able to use the
wellness/care management program to effectively model risk and
intervene, disrupting and reversing the flow of risk from low to high.
Without intervention, annual medical costs for high-risk individuals
are nearly 44 percent more than cost of low-risk individuals.
Since its launch in 2002, BHC has shown overall savings of over $30 million in annual benefit cost savings per year.
More than 1,000 physicians have also been designated as
part of BCBSM Patient-Centered Medical Home (PCMH) program, making it
the largest PCMH initiative in the nation with 300 primary care
practices located in 40 Michigan counties.
"Health and wellness programs offer real value and real
results – BHC has shown overall savings ofover $30 million in
annual benefit cost savings per year since it was launched in 2002. A
majority of members report that the program has improved their
interactions with their providers, resulting in actions that have
significantly improved their health," said Daniel J. Loepp, president
and CEO of BCBSM.
Address: Blue Cross Blue Shield Association, 225 N . Michigan Ave., Chicago, IL 60601; (312) 297-6000, www.bcbs.com.