Blue Cross Blue Shield Value-Based Care Program


The Blue Cross and Blue Shield Association (BCBSA) and BCBS Plans are spearheading initiatives to assure their 100 million members receive safe, high-quality, coordinated, and affordable care. Blue initiatives use an interconnected approach involving:

  • Changing payment incentives by moving away from fee-for-service – which rewards volume – and linking reimbursement to quality and outcomes.
  • Partnering with clinicians so they have the individualized support, data, and tools they need to be successful.
  • Engaging patients with wellness programs, transparency tools, and information on how to keep healthy and manage chronic conditions.
  • Blue Cross and Blue Shield Plans are leading the market in developing and executing value-based care programs for our members. With more than 350 programs in market across 49 states, Washington DC, and Puerto Rico, these programs focus on shifting provider payment away from volume to value. The Blues are engaging with more than 215,000 physicians – 155,000 primary care physicians and nearly 60,000 specialty physicians – to increase quality and value in healthcare spending. More than 24 million Blue Cross and Blue Shield members are currently accessing care through value-based programs such as Accountable Care Organizations, Patient-centered Medical Homes, Pay-for-Performance programs and Episode-based Payment programs.

37 Blue plans have more than 350 value-based programs in market or in development, with more than 215,000 particiapting providers providing care to nearly 24 million members. 

237 ACOs in 41 states and D.C. with more than 93,000 physicians participating. 

63 PCMH models in 48 states, D.C. and Puerto Rico with over 36,000 physicians participating. 

Fewer ED / Hospital Visits: 

So far, Wellmark BCBS’ ACOs have reduced hospital admissions by more than 20 percent.

Blue Cross Blue Shield Association said providers in its Blue Distinction Total Care program—its network of value-based care programs including accountable care organizations and patient-centered medical homes—had 10% fewer emergency department visits and saw hospitalizations decline by 15% year-over year.

Improved Health: 

Wellmark BCBS’ ACOs have boosted health and wellness screenings:

- 7 percent better HbA1c testing for diabetes patients
- 5 percent better adherence to medications for patients with cardiovascular disease

Cost Savings: 

Wellmark BCBS’ ACOs have delivered savings of more than $16 dollars per member per month.

Increased Preventive Services: 

There has also been an increase in preventive medicine, such as pediatric health screenings and immunizations. According to BCBSA, Total Care doctors, hospitals, and clinical teams are performing better than non-Total Care providers in 96% of the nationally-consistent, industry quality measures.

Other Outcomes: 





Last updated March 2019
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