BCBSNE announces new value-based total cost of care agreement with Nebraska Health Network

Delivering quality care in the most cost effective manner is the concept behind a new value-based patient-focused, total cost of care reimbursement agreement between Blue Cross and Blue Shield of Nebraska and the Nebraska Health Network.  

The Nebraska Health Network is a local, physician-led, accountable care organization that includes Nebraska Medicine, Methodist Health System and their affiliated physicians and hospitals. Fremont Health has also joined in partnership with the Nebraska Health Network in the Blue Cross and Blue Shield agreement to provide comprehensive treatment for patients in Omaha, Fremont and the Council Bluffs community.

“We are excited to expand our partnership with Blue Cross and Blue Shield of Nebraska in this value-based arrangement,” said Lee Handke, chief executive officer, Nebraska Health Network. “This program reinforces our commitment to provide high quality, cost-efficient care for our customers in the Omaha community.” 

Under this arrangement, physicians are rewarded financially if they perform better than projected on patient experience, outcomes and costs.

With this type of agreement, a higher emphasis is placed on keeping patients healthy by proactively coordinating care and reducing waste and unnecessary medical expenditures.  Quality metrics, such as accessibility, care coordination, medication monitoring and readmission management, ensure that patient care remains at the forefront while receiving care.

“The contract with Blue Cross and Blue Shield of Nebraska creates better dialogue with patients, putting our physicians and care team at the forefront of the health care plan,” said Michael Romano, MD, chief medical officer, Nebraska Health Network. “With an emphasis on care coordination our physicians are actively monitoring patients throughout the year to proactively identify areas of opportunity to improve their health.”

Patient-centered care is focused on outcomes, not just cost. “This agreement supports our belief in the critical role of the primary care physician in a patient’s health care,” said Joann Schaefer MD, chief medical officer for Blue Cross and Blue Shield of Nebraska.  “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.”

The new contract applies to the existing Select Blue (the Blue Cross select-tier health insurance plan available only in the Omaha metro area) population who are already receiving care from a Nebraska Health Network affiliated and aligned physician.  From the patient perspective, nothing changes related to how they receive and access their health care or insurance.

The Nebraska Health Network is an accountable care organization which was formed by Methodist Health System and Nebraska Medicine and their affiliated physicians and hospitals in 2010. The Nebraska Health Network is governed by a 12-member board that includes physicians and the chief financial officers from both health systems. The NHN boasts over 1,300 providers, over 300 primary care physicians, six acute care hospitals and varying post-acute and other ancillary services.

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.