Working with Blue Cross Blue Shield to Improve Patient Care

Blue Cross Blue Shield of Massachusetts (BCBSMA), a partner and member of the Greater Boston Aligning Forces for Quality Alliance, has been sharing practice pattern variation analysis data with provider organizations in the plan’s Alternative Quality Contract (AQC) global budget model since 2009. Today, more than 85 percent of the plan’s contracted primary and specialty care physicians are part of the AQC. Changing practice patterns requires individual providers and groups to think differently about what is the right care for their patients. BCBSMA has found that until it provides the data, most groups are unaware of the wide practice variation existing among practice sites, referral circles, and individual physicians in high-utilization areas such as prescribing, advanced imaging, diagnostics, and procedures. Alongside variation data on treatment of clinically specific conditions, BCBSMA provides variation data on non-emergent Emergency Department (ED) use and readmissions. The plan has seen important reductions in both rates as a result of both the data sharing and the incentives in the global budget model. Some innovations AQC providers have implemented to improve both non-emergent ED and readmissions rates include: 1) creating an enhanced care transitions program ensuring a follow-up visit within 14 days for members with chronic conditions; 2) implementing a formal multifaceted aftercare program, which includes case manager outreach calls; 3) hiring and deploying a social work team to work with patients at high risk of admission or readmission to address issues in the family, home, or community that help moderate individual patient risk and improve care and outcomes.