Blue Cross and Blue Shield of Minnesota and Minnesota Oncology have entered a five-year value-based arrangement to pay for cancer care based on patient outcomes rather than the number of services performed.
The St. Paul-based Blues said the risk arrangement will allow Minnesota Oncology to better coordinate patient care and manage members at the right time and place. It also eliminates the need for Minnesota Oncology to seek prior authorization for cancer care that follows national evidence-based guidelines.
Minnesota Oncology is a medical group with 12 clinics and more than 80 providers in the Twin Cities area.
The Blues earlier this year began providing Minnesota Oncology with additional payments for care coordination of cancer patients that are tied to quality measures, including emergency department utilization, inpatient admissions and hospice care, said Karen Amezcua, senior director of provider contracting for the Blues plan.
Those extra payments allow clinicians to perform services that normally aren't paid through a claim, such as checking on a patient over the phone. But eventually, Amezcua said the arrangement would evolve to where both organizations are at risk financially.
"When we pay for value, it allows providers the freedom to do additional services that can really drive down the cost of care," Amezcua said.
The biggest benefit of the arrangement to Minnesota Oncology is eliminating prior authorization for services that follow the National Comprehensive Cancer Network guidelines, starting on Sept. 1, said Dr. John Schwerkoske, the practice's medical director.
Eliminating that burden frees up nurses and administrative staff to devote more time to coordinating patients' care through chemotherapy and to different specialists, he said.
Moreover, he said patients "can get their treatment quicker with less hassle and less worry."
"This transformation from a volume- to value-based payment model is driven by our shared goal of delivering the best possible outcomes at a lower cost to cancer patients, many of whom struggle to afford their care, even with insurance," Dr. Craig Samitt, CEO of the Minnesota Blues, said in the news release about the arrangement. "We applaud Minnesota Oncology for stepping up to become part of the solution to the rising cost of healthcare in our state. I am confident this agreement will lead to a better care experience for the many Minnesotans impacted by this terrible disease each year."