Shifting incentives from a model that rewards volume to one that rewards value is a high-wire act. There's a jumble of terms for reimbursement and delivery alternatives—ACOs, HMOs, medical homes, bundled care and others—to help us make this transition. But our system is too big and complex for one model to solve the problem.
At Health Care Service Corp., we are pursuing value-based care because we want our members to realize the best outcomes for the dollars spent on their care. About 30% of our membership is now served through contracts with value-based payments, and that number is growing.
As the operator of Blues plans in five states, we serve diverse populations. Layered atop this complexity are the differences among providers—their integration, technological capabilities and ability to share risk. To create winning collaborations, HCSC uses a portfolio of arrangements that meet providers where they are.
For example, Blue Cross and Blue Shield of Illinois has been collaborating for nearly five years with Advocate Health Care on an accountable care organization. It has reduced key utilization measures such as emergency room visits and inpatient admissions for 360,000 members while keeping them healthy. It's a collaboration with an integrated hospital system that was making investments in value-based care even before the ACA.
In Texas, several hospital-centered ACOs are already in place, but we added to this when Blue Cross and Blue Shield of Texas recently introduced several physician-led models. One example is a collaboration with the Texas Medical Association, the largest state medical society in the U.S. Called TMA PracticeEdge, it will allow independent doctors, who make up two-thirds of Texas' physician workforce, to engage in the value-based care movement.