A new way of matchmaking: Redefining the provider-health plan relationship in value-based programmes

Natalie Mccall and Shunn P. Phillips
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Natalie Mccall: Blue Cross Blue Shield of Louisiana, USA
Shunn P. Phillips: The Baton Rouge Clinic, USA

Management in Healthcare: A Peer-Reviewed Journal, 2020, vol. 4, issue 3, 198-207

Abstract: This article demonstrates an example of a provider, the Baton Rouge Clinic (BRC), and health plan, Blue Cross Blue Shield of Louisiana (Blue Cross), collaborating in a new type of relationship, moving away from fee-for-service to value-based reimbursement. The new relationship was built through Blue Cross’s Quality Blue programmes. Under Quality Blue, BRC and Blue Cross aligned incentives, shared information and increased transparency to achieve desired outcomes. Both BRC and Blue Cross made significant investments to improve quality and lower cost. Regular feedback was provided to monitor the success of these investments. Ongoing discussions are still taking place about how to apply these successes to additional transformation efforts. This collaboration has changed the way that BRC and Blue Cross work together to improve the lives of the patients. While the achievements of this relationship have become a source of great pride, evolutions under value-based reimbursement should be continued by both organisations. Additionally, BRC should work to replicate this relationship with other health plans, and Blue Cross should, in turn, do the same with other providers.

Keywords: alternative payment models; quality improvement; cost reduction; transformation (search for similar items in EconPapers)
JEL-codes: I1 I10 (search for similar items in EconPapers)
Date: 2020
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Persistent link: https://EconPapers.repec.org/RePEc:aza:mih000:y:2020:v:4:i:3:p:198-207

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