Improving Outcomes and Lowering Costs
Total Care
Total Care recognizes doctors that focus on health care instead of sick care. These doctors go above and beyond to enhance the overall health of their patients – providing preventive services, better management of chronic conditions and reduced costs of care.
Total Care providers are reimbursed by Blue Cross and Blue Shield of Nebraska (BCBSNE) based on the quality of the care they coordinate, rather than the number of services performed. That means they are motivated to know you, your complete medical history and your preferences, and help you make informed health care decisions – to get the right care, from the right specialists, at the right places, at the right times.
Getting Total Care in Nebraska
Total Care programs are intended to make sure patients can see primary care providers who know their entire medical history, understand their preferences and effectively coordinate optimal care in collaboration with specialized practitioners.
BCBSNE partners with Accountable Care Organization (ACO) and Patient-Centered Medical Home (PCMH) providers to provide Total Care. From over 200 clinics across the state of Nebraska, 3,000 primary care physicians served 287,000 BCBSNE members in the 2021-2022 program year. That number continues to rise as more companies invest in their employees’ long-term health by teaming with us.
BCBSNE members attributed to these ACOs and PCMHs are benefiting from Total Care:*
To make sure your primary care provider is a Total Care provider or find one, use our doctor finder or login to myNebraskaBlue.com.
Accessing Total Care Nationwide
As an independent licensee of the Blue Cross and Blue Shield Association, we’re backed by the strength of a national network. We work with fellow BCBS Plans that are championing Total Care in their local markets – building close relationships with providers in their communities and ensuring high-quality total patient care for our members.
Find a Total Care provider, no matter where you live, work or travel. Learn more at BCBS.com/TotalCare »
Holding Providers Accountable
Total Care is our standard approach to measure the quality and cost of all medical care, including inpatient, outpatient, professional, pharmacy and ancillary services. Total Care is part of how all members are cared for by BCBSNE.
Believing the primary care physician plays a vital role in one’s total health care, BCBSNE works with physicians to provide data, including emergency room visits, medications and services received from other providers, so they have a complete picture of their patients’ care. This model is not about restricting care; it’s designed to help providers efficiently focus on coordinating and delivering the best possible care for their patients.
BCBSNE helps providers monitor key quality metrics, which are established and benchmarked nationally.
Providers that partner with us are supplied with the data and financial resources they need to effectively manage their patients’ care while helping them understand the costs associated with that care.
*BCBSNE member data from 2021-2022 Total Care program year.
Measures look at how well physicians:
- Educate, immunize and screen their patients to prevent disease
- Minimize the occurrence of potentially preventable hospitalizations and emergency room visits
- Manage the health care needs of members who suffer from chronic conditions
- Manage the use of generic drugs and avoid unnecessary tests for their patients
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