Doctor talking with a male patient in a hallway

Doctors Take the Driver’s Seat in Blueprint for Affordability Contracts

Seven hospitals and provider organizations recently announced they signed a new contract with Blue Cross Blue Shield of Michigan that promises to radically improve health care delivery while decreasing costs.

Blue Cross calls these contracts its Blueprint for Affordability. The first seven partners are Ascension Michigan, Henry Ford Health System, Michigan Medicine, Oakland Southfield Physicians, The Physician Alliance, Trinity Health and United Physicians.

Together, these partners account for 30% of Blue Cross’ membership under its commercial PPO and Medicare Advantage PPO health plans – and more than $4 billion in health care spend in southeast Michigan.

How it works

The Blueprint contracts are structured to hold providers accountable for the quality of care they are providing to patients. Each physician organization and health system agreed to an annual cost target for providing care to Blue Cross members.

At the end of each contract year, if an organization comes in below its cost target – and if they meet certain health care quality metrics – they will get a bonus. This is called upside risk, and previously has been used in Blue Cross contracts.

But if the costs come in above target and the health care quality metrics aren’t met, the organization will owe money to Blue Cross. This is called downside risk, and is a new mechanism being introduced in the Blueprint contracts.

“This puts doctors back in the driver’s seat,” said Stephen Carrier, senior vice president of network management and provider partner innovation at Blue Cross. “It rewards doctors for the total cost of care for a patient.”

When provider organizations and hospitals adopt upside and downside risk, there is more incentive for them to take a proactive, data-driven approach to treating the health of patients.

“As pioneers in improving the health of our communities through clinical excellence, research and medical education, our doctors understand that partnering with their patients to manage costs is a critical component of compassionate and personalized care,” said Robin Damschroder, executive vice president and chief financial officer at Henry Ford Health System.

The role of data sharing

Previously, primary care doctors were paid every time a patient walked into the office for a visit; which meant in times like flu season, lots of sick patients were profitable for the doctor’s office.

As a result of the Blueprint contracts, doctors are motivated to approach the health of their patient population differently. As flu is preventable, and often predictable, primary care doctors are in a unique position to help keep their patients healthy.

Under the Blueprint contracts, Blue Cross has agreed to provide its partners with more and better data to help them understand what’s happening in their practice or in their health system.

“Our partners told us our PPO data needs to be better – we can’t just dump data on a doctor’s desk,” Carrier said. “We’ve been working with external vendors to communicate what’s happening in a providers practice or in a system in a very succinct manner, so they know in 30 seconds what is going on. The data is the impost important piece to the whole thing.”

What Blueprint means for patients

While the Blueprint for Affordability contracts will be working behind the scenes at doctor’s offices, patients should see an improvement in the quality and coordination of their health care.

“Now physicians are paid on how well they take care of patients – no matter what their age is, what other services are rendered; it’s totally based on the result from the visit. This is the real game changer,” said Dr. Jerome Frankel, medical director at Oakland Southfield Physicians. “As patients are treated better, patients do better. Hospitalizations will decrease. For the first time, patients are taken care of better than they ever have been before.”

In addition to a better experience in the doctor’s office with the goal of fewer visits and fewer hospitalizations, the cost of health care will decrease, Carrier said.

Over time, that will have a positive affect on patient’s health care premiums – either in terms of lowering premiums or by slowing growth in premiums, Carrier said.

The primary impact patients will see from Blueprint for Affordability will be more proactive care management from providers, and more communication between hospitals and health systems and primary care doctors.

“It will force all of us in the community to provide the care that they (patients) need to prevent illness and hospitalizations,” Frankel said.

Learn more about Blueprint for Affordability at www.blueprintforaffordability.com.

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Photo credit: izusek

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