BCBSNE and Nebraska Clinics Partner on New Value-Based Payment Model

Blue Cross and Blue Shield of Nebraska (BCBSNE) is partnering with 10 health care clinics on a new method of payment for doctors that is the first of its kind in Nebraska.

BCBSNE and the South East Rural Physician Alliance Accountable Care Organization (SERPA-ACO), an affiliation of 10 independent Nebraska clinics, have signed what’s known as a “Total Cost of Care” payment contract.  Total Cost of Care is a standardized approach that measures the cost of medical care—including inpatient, outpatient, professional, pharmacy and ancillary services. 

In this innovative model, physicians are rewarded financially if they perform better than projected on patient experience, outcomes and costs; and they share in the financial risk when their patient results are less favorable than expected.

BCBSNE is the first commercial health insurance company in Nebraska to implement this type of provider payment method.  The TCC contract with SERPA-ACO goes into effect July 1, 2014.

“This agreement with SERPA-ACO supports our belief in the critical role of the primary care physician in a patient’s health care,” said Lee Handke, BCBSNE senior vice president.  “Studies have shown that the stronger a patient’s ties to his or her primary care physician, the better the quality of care received, and the more efficiently that care is delivered.”

SERPA-ACO is comprised of the following independent Nebraska clinics:

 

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.