EAGAN, Minn., April 17, 2017 /PRNewswire-USNewswire/ -- Blue Cross and Blue Shield of Minnesota (Blue Cross) announced a new strategic "Future of Health Care" initiative today aimed at addressing health care cost challenges in Minnesota and beyond. With three strategic pillars, the initiative looks to spur innovation and engagement around new approaches to help build a more stable and sustainable health care market for Blue Cross members and Minnesotans statewide.
"Health care is at a crossroads," said Michael Guyette, president and CEO of Blue Cross and Blue Shield of Minnesota, announcing the new initiative. "Costs continue to rise, and the premium dollars coming in just aren't covering the dollars going out in payments to hospitals, physicians, and drug companies. Our members are stretched. Our employer partners are stretched. We need new ideas and approaches that can help members, employers and providers move forward together.
"Blue Cross is the leading health plan in Minnesota. We can't wait for someone else to step up. We need to lead – and that's what our Future of Health Care initiative is about. We're going to innovate to make the health care market more stable and sustainable for everyone, and this is how we are moving forward."
Earlier this month, Blue Cross reported rising health care costs had pushed the state's largest health care plan to record operating losses in 2016. With a negative operating margin, the state's largest non-profit health plan said it had been necessary to dip deeply into reserves to cover costs, despite 2016 premium increases in most segments.
In Minnesota's individual market segment, Blue Cross said it had absorbed unsustainably large losses, in addition to major cost pressures in public programs and heavy utilization by Minnesotans covered under the state's Medicaid program.
The losses reported by Blue Cross were not unique. Most of Minnesota's health plans reported dismal 2016 financial performance. Medicaid losses are a particular problem, with costs reaching critical levels. There's already been significant disruption and instability for Medicaid program enrollees.
"Minnesota health care costs are a flashing red light," Guyette said. "It's not sustainable."
"We need to innovate," he said. "Blue Cross has served Minnesotans for more than 80 years. We have nearly 3 million members looking to us for leadership."
The Future of Health Care initiative has three strategic pillars – Clinical Innovation, Care Management, and Network and Payment – with specific initiatives under each:
- The Clinical Innovation pillar will help members better navigate the care system and address their specific health care needs in the best way possible through collaborative partnerships.
For example, the Mayo Clinic Living Donor Kidney Program leverages Mayo's expertise and innovative treatment for complex medical conditions. Blue Cross worked with Mayo Clinic to create a new program, launched recently by a handful of Minnesota employers, to match potential donors willing to help someone by donating a kidney, but who may not be compatible with that relative or friend. The program creates a "donor chain," matching people to donate a kidney to someone they didn't know, while someone else donates an organ to their friend or relative. Already, a "paired donation" type program is being used in 20 percent of Mayo's kidney transplant cases. The result is better clinical outcomes and lower costs for Blue Cross members. Blue Cross is also starting to guide members in need of specific orthopedic procedures and those who have low back pain to high value providers.
Other new initiatives include a new consumer-centric diabetes solution, designed in collaboration with the American Diabetes Association that features new digital tools, peer support, care coordination and value-based incentives. A new Maternity Management pilot for Blue Cross Medicaid members features early member engagement and enhanced support for new mothers-to-be. The pilot is community-based and leverages community and provider partners, including county-based public agencies, to better support women and their babies at this most important time.
- Advancing Care Management, Blue Cross says it will leverage a broad range of tools to help its members' receive better coordinated and evidence-based care, everything from basic health coaching and utilization management to care advocacy, specialty-care coordination and care transition support. The company said it will continue its emphasis on high-complexity care, leveraging dedicated managers and health coaches, while also creating a new "inter-disciplinary care rounds" approach, in which cross-functional clinical teams identify holistic approaches on behalf of members.
- In the Network and Payment pillar, the plan will focus on identifying and leveraging high value networks considering provider cost, efficiency and quality, both statewide and regionally. Building on advances and innovations in this area, Blue Cross is already working to incorporate aligned incentive contracts, patient-centered medical homes, bundled payments for key procedures, value-based contracts for Medicaid member providers, and new insurance programs leveraging Accountable Care Organizations (physicians, clinics and hospitals) capable of delivering high-value care to members.
Through payment reform, Blue Cross wants to lower the cost of care and achieve better predictability in employer and member out-of-pocket costs by establishing a care model where it pays for value, not volume, shifting to a system that rewards quality and affordability.
The results of an effective care system that prioritizes value are fewer inpatient hospitalizations, lower readmission rates, higher quality care, and more appropriate use of services when compared to volume-based care.
"We're already innovating to advance our Future of Health Care pillars," said Guyette, "but we're also going to partner with our providers, employers and members on new ideas and new approaches. We'll need everyone working together if these cost challenges are to be met."