What is Value Based Care?

The traditional way providers have been paid is known as “fee for service,” meaning that in general they are paid for each service or procedure they perform.    

Value-based care tackles the current system’s problems with fragmentation and inefficiency by paying providers based not per procedure, but on how effectively and efficiently their patients’ total care is delivered.  It is the marriage of the best elements of the “old-fashioned” doctor-patient relationship with the very latest technology and data analytics.  It represents the best of both worlds, where collaboration, coordination and an emphasis on quality result in better patient outcomes, more effective use of health care services, and lower costs.

Our value-based care partners

We partner with Nebraska health care providers for two types of value-based care arrangements:

  • Patient-Centered Medical Homes
    Under this model, the patient’s primary care physician acts as the “quarterback” for the medical team responsible for coordinating all the patient’s care, to ensure achievement of the Triple Aim.  Payment incentives are awarded for surpassing quality metrics while delivering care more efficiently.
  • Accountable Care Organizations
    ACOs are groups of doctors and other health care providers who join together to provide coordinated care to their patients.  Payment is tied to achievement of quality and cost outcome metrics.

Our value-based care programs currently impact nearly 300,000 Blue Cross and Blue Shield members.

 

PCMH (24)
  • 90 clinics
  • 429 providers
  • 78,089 attributed members
ACO (7)
  • 186 clinics
  • 921 providers
  • 211,691 attributed members

Date as of June 2017*

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.