At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we believe that improving the way healthcare is delivered will help our members improve their health.
In fact, this is key to helping control long-term healthcare costs. The health—and healthcare costs—of other BCBSRI members directly affect your healthcare costs. So when individuals are healthier, it helps moderate costs for you and the rest of our members.
That's why we're taking bold steps to change the healthcare delivery system in Rhode Island. We think the best opportunity to truly reform healthcare is on the local level where the care is delivered. By changing the way we work with local primary care physicians, we're helping to shift the healthcare delivery system from one that focuses on "sick" care to one that focuses on "health" care. You'll be at the center of this system. With our new approach, you can expect better, safer care, including more services to keep you healthy.
What this means for you
We're changing to make a real difference in your healthcare. While it won't happen overnight, here are just some of the improvements you'll experience now and in the future:
Coordinated care if you have a chronic or complex condition
If you have multiple chronic health conditions, you will get the best, safest care when you have someone to help you oversee all the healthcare you receive. That's why BCBSRI is partnering with local primary care physician groups to open patient-centered medical homes. This type of practice offers you an ongoing relationship with a primary care physician who leads a team of healthcare professionals in helping you take responsibility for improving your health. With this type of coordinated care, you may be able to avoid unnecessary doctor's visits, repeat testing, conflicting combinations of medication, and other safety issues.
BCBSRI also is stepping up our own care coordination services for members with a chronic condition such as diabetes or heart disease. This care coordination offers an ongoing relationship with a healthcare professional who will work directly with you and your doctor on improving your health.
How it will improve care
You'll have customized one-on-one support to help you keep track of your healthcare, manage your condition, and live a healthier life. If you're caring for a family member with health concerns, this added support will benefit you and your loved one.
How it will save money
Coordinated care focuses on improving or maintaining health and reducing the risk of complications. This saves money on copayments and other out-of-pocket medical costs. It also helps moderate long-term healthcare costs for everyone.
Aligning financial incentives with quality care
In the current system, doctors are paid based on how many services they perform, not the quality of care they provide. BCBSRI is developing a pay-for-performance model of reimbursement that will reimburse doctors for their performance on certain care quality targets. For example, doctors who could show that their patients with diabetes got all their tests on time would get paid more than doctors whose patients fell behind on their tests.
How it will improve care
Doctors are paid more when they help their patients better manage their health conditions, which helps reduce complications and improve health.
How it will save money
It creates financial incentives for doctors to provide higher quality and more cost-effective care for our members.
Tools and data to help you make more informed healthcare decisions
When deciding on diagnosis and treatment, doctors need access to medical information based on the most proven science available. Medicine is always changing, so what worked best a few years ago might not be the best treatment today. If you were diagnosed with a medical condition such as heart disease, you'd want your doctor to talk with you about the treatment options that are shown to be most successful. This is called evidence-based medicine. To promote the use of evidence-based medicine, BCBSRI is providing tools to doctors and members. Those tools will be available later this year.
How it will improve care
Basing diagnosis and treatment decisions on evidence-based medicine improves patient safety, prevents avoidable deaths, and improves overall care.
How it will save money
In 2008, variations in care for diagnosing, treating, and managing diabetes alone accounted for about 46,000 avoidable deaths and up to $4.5 billion in avoidable hospital costs and lost worker productivity.
