Benefits Of Value Based Care

The success of a value-based care program isn’t just based on a reimbursement model.  Blue Cross and Blue Shield of Nebraska’s strategy combines provider reimbursement, benefit plan and network design and population health to drive better patient outcomes and help you save.

Employer Advantages

  • A shift away from unsustainable year-over-year trend increases
  • Reporting on the value the programs deliver in terms of quality and savings
  • Encourages better coordinated care, which results in savings without sacrificing quality
  • Motivates employees to be more active participants in their own health care
  • Healthier employees result in a more productive workforce with fewer absences

Member advantages

  • Better quality of care and health outcomes
  • Coordinated care leads to simplified, personalized health care
  • Care is focused on prevention and wellness to keep patients healthy longer
  • Improved satisfaction with the health care experience
  • Medical cost savings lead to lower premiums over time

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.