Blue Cross & Blue Shield of Illinois is teaming up with other Blue plans to help large employers control rising medical costs and improve care for employees.
Known as the Blue high-performance network, the program aims to direct patients toward healthcare providers that consistently offer high-quality care at a lower cost. It's the first program in 25 years to be driven by the Blue Cross Blue Shield Association—a federation of 36 independent Blue companies—rather than the plans themselves, said Jennifer Atkins, vice president of network solutions for the association.
The Blue high-performance network, or HPN, will launch January 2021 in 55 markets reaching more than 185 million people nationwide. It was designed for large national and regional employers, who Atkins said wanted more consistent quality measurements and prices across the markets in which they operate.
"We understand the competitor landscape, both on a national and also a local level," Atkins said. "So, when you have large national employers that are looking for consistency across markets, it became really important to us to come together as one within the Blue HPN to meet that market need."
More employers are turning to high-performance networks to help workers choose healthcare providers that offer better quality care at competitive costs, according to a 2018 survey from brokerage and advisory company Willis Towers Watson.
Of the 255 U.S. employers that responded to the survey, 65 percent said they plan to include high-performance networks in their health plans by 2020. Meanwhile, only 28 percent of employers had such networks in 2017.
"With individual plans, we have been focused on value-based care, cost and quality for a long time. And this is our effort to bring that to a national market," Atkins said.
Independent Blue plans are selecting healthcare providers based on existing relationships and quality measurements, including following evidence-based treatment guidelines and detecting chronic conditions. Though, there will be some differences depending on the market.
For example, if diabetes and maternal health are larger concerns in the Chicago area, Blue Cross & Blue Shield of Illinois, along with local healthcare providers, "can work together on those measures that make sense for the market to improve overall outcomes," Atkins said.
The last time the Blue Cross Blue Shield Association brought Blues plans together to serve a nationwide marketplace was 25 years ago, when it launched BlueCard. The program enables members to seek treatment from participating healthcare providers while traveling or living in another Blue plan's service area.
This article was originally published in Crain's Chicago Business.